Location in the Right Hemi-Colon Is an Independent Risk Factor for Delayed Post-Polypectomy Hemorrhage: A Multi-Center Case-Control Study
Location in the Right Hemi-Colon Is an Independent Risk Factor for Delayed Post-Polypectomy Hemorrhage: A Multi-Center Case-Control Study
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DOI：
10.1038/ajg.2010.507
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发表时间：
2011-06-01
影响因子：
9.8
通讯作者：
ter Borg, Frank
中科院分区：
文献类型：
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作者：
Buddingh, K. Tim;Herngreen, Thomas;ter Borg, Frank
延迟性出血是结肠镜息肉切除术的一种罕见但严重的并发症。大尺寸是唯一被明确证明会增加延迟出血风险的息肉相关因素。有人建议，在右半结肠的位置也是一个危险因素。本研究的目的是确定息肉位置是否是延迟性息肉切除术后出血的独立危险因素。METHODS：一项回顾性病例对照研究在两所大学医院和两所社区hospitals.RESULTS：39例和117例对照被确定。多因素分析显示，息肉的大小和部位是延迟性出血的独立危险因素。息肉直径每增加1 mm，危险性增加13%（比值比（OR）1.13，95%可信区间（CI）1.05-1.20，P < 0.001）。位于右半结肠的息肉延迟出血的OR为4.67（1.88-11.61，P = 0.001）。在单因素分析中，盲肠息肉似乎特别具有高风险（OR 13.82，95%CI 2.66-71.73），但由于病例数太少，无法在多因素分析中评估。息肉类型（无蒂或有蒂）不是一个危险因素。结论：息肉的位置在右半结肠似乎是一个独立的和实质性的危险因素，延迟后息肉切除术出血。当从该区域切除息肉时，建议采取低阈值的预防性止血措施。
OBJECTIVES: Delayed hemorrhage is an infrequent, but serious complication of colonoscopic polypectomy. Large size is the only polyp-related factor that has been unequivocally proven to increase the risk of delayed bleeding. It has been suggested that location in the right hemi-colon is also a risk factor. The objective of this study was to determine whether polyp location is an independent risk factor for delayed post-polypectomy hemorrhage.METHODS: A retrospective case-control study was conducted in two university hospitals and two community hospitals.RESULTS: Thirty-nine cases and 117 controls were identified. In multivariate analysis, size and location were found to be independent polyp-related risk factors for delayed type hemorrhage. The risk increased by 13% for every 1 mm increase in polyp diameter (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.05-1.20, P < 0.001). Polyps located in the right hemi-colon had an OR of 4.67 (1.88-11.61, P = 0.001) for delayed hemorrhage. Polyps in the cecum seemed to be especially at high risk in univariate analysis (OR 13.82, 95% CI 2.66-71.73), but this could not be assessed in multivariate analysis as the number of cases was too small. Polyp type (sessile or pedunculated) was not a risk factor.CONCLUSIONS: Polyp location in the right hemi-colon seems to be an independent and substantial risk factor for delayed post-polypectomy hemorrhage. A low threshold for preventive hemostatic measures is advised when removing polyps from this region.