A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
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DOI：
10.1016/j.cgh.2016.03.021
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发表时间：
2016-08-01
影响因子：
12.6
通讯作者：
Valdivielso, Eduardo
中科院分区：
文献类型：
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作者：
Albeniz, Eduardo;Fraile, Maria;Valdivielso, Eduardo
背景与目的：内镜下结直肠黏膜切除术（EMR）后，迟发性出血是最常见的严重并发症，但没有预防指南。我们的目的是确定与延迟出血相关的危险因素，这些延迟出血在出院后直到第15天需要医疗护理，并开发一个评分系统来识别风险患者。我们对1214例连续的20 mm或更大的无蒂结直肠病变患者进行了EMR治疗的前瞻性研究（n = 1255），2013年2月至2015年2月在西班牙23家医院进行。术后15天对患者进行检查，并收集医疗数据。我们使用这些数据创建了一个迟发性出血评分系统，并根据多变量logistic回归分析的β参数为每个风险因素分配权重。结果：46例患者发生延迟性出血（3.7%，95%可信区间，2.7%-4.9%）。在多变量分析中，与迟发性出血相关的因素包括年龄≥ 75岁（优势比[OR]，2.36; P
BACKGROUND & AIMS: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk.METHODS: We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the beta parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding.RESULTS: Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age >= 75 years (odds ratio [OR], 2.36; P