Bleeding After Elective Interventional Endoscopic Procedures in a Large Cohort of Patients With Cirrhosis.
Bleeding After Elective Interventional Endoscopic Procedures in a Large Cohort of Patients With Cirrhosis.
复制标题
大量肝硬化患者的选择性介入性内窥镜手术后出血。
DOI：
10.14309/ctg.0000000000000288
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发表时间：
2020-12-17
影响因子：
3.6
通讯作者：
Orman ES
中科院分区：
文献类型：
--
作者：
Kundumadam S;Phatharacharukul P;Reinhart K;Yousef A;Shamseddeen H;Pike F;Patidar KR;Gromski M;Chalasani N;Orman ES
Elective therapeutic endoscopy is an important component of care of cirrhotic patients, but there are concerns regarding the risk of bleeding. This study examined the incidence, risk factors, and outcomes of bleeding after endoscopic variceal ligation (EVL), colonoscopic polypectomy, and endoscopic retrograde cholangiopancreatography with sphincterotomy in cirrhotic patients. A cohort study of patients with cirrhosis who underwent the above procedures at a single center between 2012 and 2014 was performed. Patients with active bleeding at the time of procedure were excluded. Patients were followed for 30 days to assess for postprocedural bleeding and for 90 days for mortality. A total of 1,324 procedures were performed in 857 patients (886 upper endoscopies, 358 colonoscopies, and 80 endoscopic retrograde cholangiopancreatograpies). After EVL, bleeding occurred in 2.8%; after polypectomy, bleeding occurred in 2.0%; and after sphincterotomy, bleeding occurred in 3.8%. Independent predictors of bleeding after EVL and polypectomy included younger age and lower hemoglobin. For EVL, bleeding was also associated with infection and model for end-stage liver disease-Na. International normalized ratio was associated with bleeding in univariate analysis only, and platelet count was not associated with bleeding in any procedure. Bleeding after EVL was associated with 29% 90-day mortality, and bleeding after polypectomy was associated with 14% mortality. Of the 3 patients with postsphincterotomy bleeding, none were outliers regarding their baseline characteristics. In patients with cirrhosis, bleeding occurs infrequently after elective therapeutic endoscopy and is associated with younger age, lower hemoglobin, and high mortality. Consideration of these risk factors may guide appropriate timing and preprocedural management to optimize outcomes.
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影响因子：
29.4
作者：
Rabeneck, Linda;Paszat, Lawrence F.;Stukeli, Therese A.
通讯作者：
Stukeli, Therese A.
影响因子：
7.7
作者：
Kovalak, Mary;Lake, Jeremy;Zaman, Atif
通讯作者：
Zaman, Atif
影响因子：
2.6
作者：
Navaneethan U;Njei B;Zhu X;Kommaraju K;Parsi MA;Varadarajulu S
通讯作者：
Varadarajulu S
影响因子：
1.6
作者：
Cho E;Jun CH;Cho SB;Park CH;Kim HS;Choi SK;Rew JS
通讯作者：
Rew JS
影响因子：
7.7
作者：
Adler, Douglas G.;Haseeb, Abdul;Siddiqui, Ali
通讯作者：
Siddiqui, Ali