Risk Factors for Intraprocedural and Clinically Significant Delayed Bleeding After Wide-Field Endoscopic Mucosal Resection of Large Colonic Lesions.

Departments of Gastroenterology and Hepatology, University of Sydney at Westmead Hospital, Sydney, NSW
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 7.9). 09/2013; 12(4). DOI: 10.1016/j.cgh.2013.09.049
Source: PubMed


& 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 following it (clinically significant post-EMR bleeding, CSPEB). We investigated factors associated with IPB and CSPEB in a large prospective study.
We analyzed data from WF-EMRs of sessile colorectal polyps ≥20 mm in size (mean size, 35.5mm), performed on 1172 patients (mean age 67.8 y) from June 2008 through 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.
Of the patients studied, 133 had IPB (11.3%). Independent predictors included increasing lesion size (odds ratio [OR], 1.24/10 mm; P <.001), Paris endoscopic classification of 0-IIa+Is (OR, 2.12; P=.004), tubulovillous or villous histology (OR, 1.84; P=.007), and study institutions that performed the procedure on fewer than 75 patients (OR, 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 had CSPEB (6.2%). On multivariable analysis, CSPEB was associated with proximal colon location (OR, 3.72; P <.001), use of an electrosurgical current not controlled by a microprocessor (OR, 2.03; P=.038) and IPB (OR, 2.16; P=.016). Lesion size and comorbidities did not predict CSPEB.
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. IBP 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.

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