Aims Endoscopic resection (ER) is associated with a reduction in the incidence of colorectal
cancer by 76-90%. However, it is an invasive procedure and is not free from complications.
Bleeding is the most common complication and has a variable incidence (1.5-2.8% intraprocedural
bledding [IPB]; 0.3-6.1% post-polypectomy bleeding [PPB]). Anticoagulation (AC), location
in the right colon, dimension>30mm and use of prophylactic hemoclip (HC) in the right
colon are risk factors (RF) for PPB. The risk of PIB appears to be higher in lateral
spreading tumor (LST) and polyps (Pps)>40mm. We aimed to analyse the rate of haemorrhage
associated with colorectal ER (PIB and PPB) and relate it to patient characteristics,
Pps and the technique used.
Methods Retrospective cohort study, based on a prospectively collected database, covering
a period of 6 years (January 2014 to December 2019). Patients undergoing mucosectomy
(EMR) of large non-pedunculate Pps (>20mm) were included. Demographic data, Pps and
EMR characteristics were analysed. IPB was defined as bleeding detected during the
procedure and submitted to endoscopic therapy and PPB was defined as bleeding within
30 days after the procedure and which led to a visit to the hospital. Statistical
analysis performed with SPSS (X2 test, Fishers exact test, odds ratio).
Results In the sample of 361 patients (64% male; mean age 56 years), the overall bleeding
rate was 19.3% (IPB 16.9% and PPB 3%). Around 22% were antiaggregated (AAG)/AC, which
was associated with an increased risk of PPB (p-value>0.05). Most PPB didn’t require
transfusion support and colonoscopy was performed without endoscopic therapy. The
majority of Pps were LST (n=282) and had an SMSA score 3-4 (n=260), which was associated
with a higher incidence of IPB (p-value 0.047). The right colon was the most common
location (65.7%) and there was no difference in the incidence of PPB compared to the
left colon. Approximately 25% of Pps were>30 mm in size, which was associated with
a higher incidence of PIB (p-value 0.001). Half of the Pps underwent en bloc EMR with
a diathermic loop (53%), which was associated with a lower incidence of IPB (p-value
0.016). HC were applied to 51% of Pps (intent: 68% (n=123) prophylactic; 32% (n=57)
therapeutic [IPB]). The rate of prophylactic HC was 36% in the right colon and 30%
in the left colon, associated with a reduced risk of PPB (OR 0.159; 95% CI [0.006;
3.835]). [1]
[2]
[3]
[4]
[5]
[6]
Conclusions The incidence of PPB was similar to values reported internationally, however the
incidence of IPB was higher (no data from national portuguese series available). EMR
proved to be safe in patients undergoing AAG/AC, despite the increased risk of PPB.
The complexity of the Pps defined by the SMSA score appeared to signal an increased
risk of PPB. The application of prophylactic HC was associated with a reduction in
the risk of PPB.
