A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions.

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 ß 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 < .01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P ≤ .05), aspirin use during EMR (OR, 3.16; P < .05), right-sided lesions (OR, 4.86; P < .01), lesion size ≥40 mm (OR, 1.91; P ≤ .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P ≤ .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively. CONCLUSIONS: The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.

Prevención, cribado y seguimiento de las neoplasias colorrectales / Prevention, screening and follow-up of colorectal tumors

Una de las principales novedades presentadas en la Digestive Disease Week (DDW) de 2006 fue la presentación de las guías clínicas de seguimiento de los adenomas colorrectales. Esta nueva guía persigue un doble objetivo: la identificación de los factores de riesgo de recurrencia y diferenciar a 2 grupos de pacientes, los de bajo y los de alto riesgo de recurrencia. Esta división ha de permitir optimizar un recurso escaso, la colonoscopia, evitando colonoscopias innecesarias, y destinar este recurso escaso al cribado. Se dedicó especial atención, además, a recalcar la importancia crítica de una excelente colonoscopia inicial en toda pauta de seguimiento de pacientes con adenoma colorrectal, no únicamente en relación con el requerimiento de una excelente preparación sino también con la importancia del tiempo de duración de la exploración durante la retirada del endoscopio. Finalmente, se presentaron diferentes estudios de seguridad y eficacia de fármacos con potencial efecto quimiopreventivo en el desarrollo de adenomas (AU)

One of the main novelties of Digestive Diseases Week (DDW) of 2006 was the presentation of the clinical guidelines for surveillance of colorectal adenomas. The objective of these guidelines is two-fold: to identify risk factors for recurrence and to differentiate two groups of patients, those with low risk and those with high risk of recurrence. This division should allow a scarce resource – colonoscopy – to be optimized, avoiding unnecessary colonoscopies and allowing this technique to be reserved for screening. The crucial importance of an excellent initial colonoscopy in the follow-up of patients with colorectal adenoma was also highlighted, not only in relation to the requirement of optimal preparation but also the importance of the time and duration of the procedure during endoscope withdrawal. Finally, several studies on the safety and efficacy of drugs with a potential chemopreventive effect in the development of adenomas were presented (AU)