Clinical characteristics and risk factor analysis of delayed bleeding after endoscopic mucosal resection for colon polyps / 解放军医学杂志

ABSTRACT

Objective: To analyze the clinical features of hemorrhage after colon polypectomy with endoscopic mucosal resection (EMR) in order to provide guidance for prevention of postoperative bleeding. Methods: We reviewed 922 cases of colon polypectomy with EMR in the Gastroenterological Department of the Sixth Medical Center of Chinese PLA General Hospital during January 1, 2016 to May 1, 2018. According to whether postoperative bleeding happened, cases were classified as bleeding group (37 cases) and non-bleeding group (885 cases), and a comparative analysis of general data, combined disease, polyp conditions and EMR operation was performed in the two groups. Results: The proportion of long-term smoking in the bleeding group (37.8%) was significantly higher than that in the non-bleeding group (18.8%, P<0.05). The proportion of patients with hypertension, diabetes, cardiovascular disease, chronic liver disease or chronic kidney disease in the bleeding group was not significantly different from the non-bleeding group. The proportion of patients with polyps located in multiple intestine segments (35.1%) was higher in the bleeding group than that in the non-bleeding group (18.2%, P<0.05). The number of resections, maximum basal diameter and mean basal diameter [1.81 ± 1.08, (0.95 ± 0.35) cm, (0.83 ± 0.31) cm] were significantly higher than those in the non-bleeding group [1.43 ± 0.85, (0.76 ± 0.27) cm, (0.71 ± 0.23) cm, P<0.05]. The proportions of titanium clips with sparse coverage, incomplete coverage, and lodging (40.5%, 43.2%, 48.7%) in hemorrhage group were significantly higher than those in the non-bleeding group (11.2%, 10.1%, 22.3%, P<0.05). Logistic regression analysis showed that long term smoking, maximum basal diameter of polyps, sparse titanium clip, incomplete coverage, and lodging were independent risk factors for delayed hemorrhage after EMR. Conclusion: In the patients with long-term smoking, large diameter of polyp basement or poor sealing of titanium clips, the wound is prone to bleeding after EMR. Titanium clip sealing is an important measure to prevent delayed bleeding.