Format

Send to

Choose Destination
J Gastroenterol Hepatol. 2017 Nov;32(11):1846-1851. doi: 10.1111/jgh.13804.

Association between the ulcer status and the risk of delayed bleeding after the endoscopic mucosal resection of colon.

Author information

1
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND AND AIM:

Bleeding is the most common adverse event following colonoscopic endoscopic mucosal resection (EMR). We aimed to assess the clinical outcomes of a colon EMR according to the post-EMR ulcer status and determine the risk factors of delayed postpolypectomy bleeding (DPPB) based on the post-EMR ulcer status.

METHODS:

The medical records and endoscopic images of patients who underwent EMR of colon polyps with diameters of ≥ 5 mm were retrospectively reviewed by us. If any exposed vessels were observed on the post-EMR ulcer, the types of exposed vessels were classified into cut and uncut vessels. The coagulation injuries on the post-EMR ulcer were categorized as grades 1, 2, or 3.

RESULTS:

In total, 505 patients with 728 polyps were examined. Exposed vessels were present in 416 post-EMR ulcers, including cut vessels in 11 (1.5%) and uncut vessels in 405 (55.6%). With regard to coagulation injury, 113 (15.5%), 443 (60.9%), and 172 (23.6%) post-EMR ulcers had grades 1, 2, and 3 injuries, respectively. DPPB was observed in 20 lesions (2.7%). Multivariate analysis indicated that a polyp size > 10 mm (odds ratio [OR], 3.354; 95% confidence interval [CI], 1.229-9.154), cut vessels (OR, 18.913; 95% CI, 3.106-115.187), and grade 3 coagulation injury (OR, 16.796; 95% CI, 1.825-154.556) were associated with DPPB.

CONCLUSIONS:

Cut vessels and severe coagulation injury on post-EMR ulcers, as well as larger polyp size, are risk factors for DPPB. Careful inspection of post-EMR ulcers and prophylactic hemostasis, if necessary, may improve the clinical outcomes of colonoscopic EMR.

KEYWORDS:

colonic polyps; hemorrhage; risk factors; ulcer

PMID:
28422327
DOI:
10.1111/jgh.13804
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center