Risk factors for delayed hemorrhage after colonic endoscopic mucosal resection in patients who did not receive antithrombotic therapy: retrospective analysis of 3844 polyps of 1660 patients
Risk factors for delayed hemorrhage after colonic endoscopic mucosal resection in patients who did not receive antithrombotic therapy: retrospective analysis of 3844 polyps of 1660 patients
复制标题
未接受抗栓治疗的结肠内镜黏膜切除术后迟发性出血的危险因素：1660例患者3844个息肉的回顾性分析
作者：
Tsuruta S;Tominaga N;Ogata S;Tsuruoka N;Sakata Y;Shimoda R;Eguchi Y;Anzai K;Hara M;Fujimoto K
背景/目的：结肠内镜下粘膜切除术（EMR）对于无需抗血栓治疗的患者是安全的；然而，EMR 与多种风险相关。本研究旨在评估未经抗血栓治疗而接受 EMR 的患者迟发性出血的风险。 方法：在本项回顾性单中心研究中，2012 年 3 月至 2016 年 12 月期间，1,792 名未经抗血栓治疗的患者在佐贺医疗中心 Koseikan 接受了结肠 EMR。根据患者和病变特征、内窥镜医师的经验和预防性血夹评估危险因素。迟发性出血定义为 EMR 后 >24 小时应用紧急内镜止血的出血。结果：在 1,792 名患者中，对 1,660 名患者的 3,844 个肿瘤进行了评估。 43 名患者（2.6%）发生迟发性出血，46 名息肉患者（1.2%）发生迟发性出血。 996 名患者（60.0%）使用了预防性血夹。单变量分析表明，与 > 60 岁患者相比，年轻患者（3-39 岁，p< 0.001、40-59 岁，p= 0.005）发生迟发性出血的频率更高，并且与大息肉（> 10 mm，p= 0.003）、血夹（p= 0.019）和有蒂息肉（p= 0.024）相关。多变量分析表明，出血的危险因素是年轻（年龄3-39岁p<0.001，40-59岁，p=0.005）和大息肉（>10mm，p<0.001）。息肉尺寸每增加 1 毫米，迟发性出血的风险就会增加 8%。 结论：本研究表明，年轻（60 岁以下）和息肉尺寸较大是未经抗血栓治疗的患者在结肠 EMR 后引起迟发性出血的危险因素。
Background/Aims:Colonic endoscopic mucosal resection (EMR) is safe for patients without antithrombotic therapy; however, EMR is associated with several risks. This study was performed to evaluate the risk of delayed hemorrhage in patients undergoing EMR without antithrombotic therapy.Methods:In the present retrospective single-center study, 1,792 patients without antithrombotic therapy underwent colonic EMR from March 2012 to December 2016 at the Saga Medical Centre Koseikan. Risk factors were evaluated with respect to patient and lesion characteristics, the endoscopist’s experience, and preventive hemoclips. Delayed hemorrhage was defined as bleeding for which emergency endoscopic hemostasis was applied >24 h after EMR.Results:Among the 1,792 patients, 1,660 with 3,844 tumors were evaluated. Delayed hemorrhage occurred in 43 patients (2.6%) and 46 polyps (1.2%). Preventive hemoclips were applied in 996 patients (60.0%). Univariate analysis indicated that delayed hemorrhage occurred more frequently in young patients (3–39 years,p< 0.001, 40–59 years,p= 0.005) compared to > 60 years and in association with large polyps (> 10 mm,p= 0.003), hemoclip (p= 0.019), and pedunculated polyps (p= 0.024). Multivariate analysis indicated that risk factors for hemorrhage were young age (age of 3–39 yearsp< 0.001, 40–59 years,p= 0.005) and large polyps (> 10 mm,p< 0.001). The risk of delayed hemorrhage was increased by an estimated 8% with a 1-mm increase in polyp size.Conclusion:The present study suggests that young age (under 60 years old) and large polyp size are risk factors for causing delayed hemorrhage after colonic EMR in patients without antithrombotic therapy.