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Title: Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic musocal resection of large colonic lesions.
Epworth Authors: Brown, Gregor
Other Authors: Burgess, Nicholas
Metz, Andrew
Williams, Stephen
Singh, Rajvinder
Tam, William
Hourigan, Luke
Zanati, Simon
Sonson, Rebecca
Bourke, Michael
Keywords: ACE Study
Colorectal Neoplasms
Intraprocedural Bleeding
Clinically Significant Post-Endoscopic Bleeding
Sessile Colorectal Polyps
Australian Colonic Endoscopic Resection Study
Multiple Logistic Regression Analysis
Tubulovillous or Villous Histology
Paris Endoscopic Classification
Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne VIC, Australia.
Issue Date: Apr-2014
Publisher: W.B. Saunders for the American Gastroenterological Association
Citation: Clin Gastroenterol Hepatol. 2014 Apr;12(4):651-61.e1-3.
Abstract: BACKGROUND & AIMS: Wide-field endoscopic mucosal resection (WF-EMR) of large sessile colonic polyps is a safe and cost-effective outpatient treatment. Bleeding is the main complication. Few studies have examined risk factors for bleeding during the procedure (intraprocedural bleeding [IPB]) or after it (clinically significant post-endoscopic bleeding [CSPEB]). We investigated factors associated with IPB and CSPEB in a large prospective study. METHODS: We analyzed data from WF-EMRs of sessile colorectal polyps ≥ 20 mm in size (mean size, 35.5 mm), which were performed on 1172 patients (mean age, 67.8 years) from June 2008-March 2013 at 7 tertiary hospitals as part of the Australian Colonic Endoscopic Resection Study. Data were collected on characteristics of patients and lesions, along with outcomes of procedures and clinical and histologic analyses. Independent predictors of IPB and CSPEB were identified by multiple logistic regression analysis. RESULTS: Of the patients studied, 133 (11.3%) had IPB. Independent predictors included increasing lesion size (odds ratio, 1.24/10 mm; P < .001), Paris endoscopic classification of 0-IIa + Is (odds ratio, 2.12; P = .004), tubulovillous or villous histology (odds ratio, 1.84; P = .007), and study institutions that performed the procedure on fewer than 75 patients (odds ratio, 3.78; P < .001). All IPB was successfully controlled endoscopically. IPB prolonged procedures and was associated with early recurrence (relative risk, 1.68; P = .011). Seventy-three patients (6.2%) had CSPEB. On multivariable analysis, CSPEB was associated with proximal colon location (odds ratio, 3.72; P < .001), use of an electrosurgical current not controlled by a microprocessor (odds ratio, 2.03; P = .038), and IPB (odds ratio, 2.16; P = .016). Lesion size and comorbidities did not predict CSPEB. CONCLUSIONS: In a prospective study of patients undergoing WF-EMR of large sessile colonic polyps, IPB is associated with larger lesions, lesion histology, and Paris endoscopic classification of type 0-IIa + Is. IPB prolongs the duration of the procedure, is a marker for recurrence, and is associated with CSPEB. CSPEB occurs most frequently in the proximal colon and less when current is controlled by a microprocessor.
DOI: 10.1016/j.cgh.2013.09.049
PubMed URL:
ISSN: 1542-3565
Journal Title: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Type: Journal Article
Affiliated Organisations: Department of Gastroenterology and Hepatology, University of Sydney at Westmead Hospital, Sydney, NSW, Australia
Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, SA, Australia
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
Department of Gastroenterology and Hepatology, Greenslopes Private Hospital, Brisbane, QLD, Australia.
Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, VIC, Australia
Department of Gastroenterology and Hepatology, Western Hospital, Melbourne, VIC, Australia.
Type of Clinical Study or Trial: Prospective Cohort Study
Appears in Collections:General Surgery and Gastroenterology

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