Management and Outcomes of Bleeding Within 30 Days of Colonic Polypectomy in a Large, Real-Life, Multicenter Cohort Study.

Autor:	Rodríguez de Santiago E; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria Universidad de Alcalá, Madrid, Spain., Hernández-Tejero M; Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universitat de Barcelona, Barcelona, Spain., Rivero-Sánchez L; Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universitat de Barcelona, Barcelona, Spain., Ortiz O; Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universitat de Barcelona, Barcelona, Spain., García de la Filia-Molina I; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria Universidad de Alcalá, Madrid, Spain., Foruny-Olcina JR; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria Universidad de Alcalá, Madrid, Spain., Prieto HMM; Gastroenterology Department, Hospital Universitario de Salamanca, University of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain., García-Prada M; Gastroenterology Department, Hospital Universitario de Salamanca, University of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain., González-Cotorruelo A; Gastroenterology Department, Hospital Universitario de Salamanca, University of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain., De Jorge Turrión MA; Gastroenterology Unit, Hospital Universitario de Cabueñes, Gijón, Spain., Jiménez-Jurado A; Gastroenterology Unit, Hospital Universitario de Cabueñes, Gijón, Spain., Rodríguez-Escaja C; Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain., Castaño-García A; Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain., Outomuro AG; Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain., Ferre-Aracil C; Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid., de-Frutos-Rosa D; Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid., Pellisé M; Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universitat de Barcelona, Barcelona, Spain. Electronic address: mpellise@clinic.cat.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2021 Apr; Vol. 19 (4), pp. 732-742.e6. Date of Electronic Publication: 2020 Apr 06.
DOI:	10.1016/j.cgh.2020.03.068
Abstrakt:	Background & Aims: Management of delayed (within 30 days) postpolypectomy bleeding (DPPB) has not been standardized. Patients often undergo colonoscopies that do not provide any benefit. We aimed to identify factors associated with therapeutic intervention and active bleeding after DPPB. Methods: We performed a retrospective study of 548 patients with bleeding within 30 days after an index polypectomy (DPPB; 71.9% underwent colonoscopy, 2.6% underwent primary angiographic embolization, and 25.5% were managed without intervention) at 6 tertiary centers in Spain, from January 2010 through September 2018. We collected demographic and medical data from patients. The primary outcomes were the need for therapeutic intervention and the presence of active bleeding during colonoscopy. Results: A need for therapeutic intervention was associated independently with the use of antithrombotic agents, hemoglobin decrease greater than 2 g/dL, hemodynamic instability, and comorbidities (P < .05). The bleeding point during colonoscopy was identified in 344 patients; 74 of these patients (21.5%) had active bleeding. Active use of anticoagulants (odds ratio [OR], 2.6; 95% CI, 1.5-4.5), left-sided polyps (OR, 1.95; 95% CI, 1-3.8), prior use of electrocautery (OR, 2.6; 95% CI, 1.1-6.1), and pedunculated polyp morphology (OR, 1.8, 95% CI, 1-3.2) significantly increased the risk of encountering active bleeding. We developed a visual nomogram to estimate the risk of active bleeding. Overall, 43% of the cohort did not require any hemostatic therapy. Rebleeding (<6%) and transfusion requirements were low in those managed without intervention. Conclusions: In a study of patients with DPPB, we found that almost half do not warrant any therapeutic intervention. Colonoscopy often is overused for patients with DPPB. We identified independent risk factors for active bleeding that might be used to identify patients most likely to benefit from colonoscopy. (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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