Effect of Instruction on Preventing Delayed Bleeding After Colorectal Polypectomy and Endoscopic Mucosal Resection
| Autor: | Katsuyuki Tozawa, Tadayuki Oshima, Jiro Watari, Akio Tamura, Masashi Fukushima, Takashi Kondo, Hirokazu Fukui, Ken Hara, Takuya Okugawa, Tomohiro Ogawa, Toshihiko Tomita, Tomoaki Kono, Hirotsugu Eda, Keisuke Nakai, Hiroto Miwa |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment cold snare polypectomy lcsh:Medicine Endoscopic mucosal resection instruction Article 03 medical and health sciences 0302 clinical medicine Antithrombotic Medicine delayed bleeding business.industry Medical record Incidence (epidemiology) lcsh:R Retrospective cohort study General Medicine colorectal polyps antithrombotic agents Polypectomy Surgery 030220 oncology & carcinogenesis Colorectal Polyp Hemostasis 030211 gastroenterology & hepatology business |
| Zdroj: | Journal of Clinical Medicine, Vol 10, Iss 928, p 928 (2021) Journal of Clinical Medicine Volume 10 Issue 5 |
| DOI: | 10.21203/rs.3.rs-97720/v1 |
| Popis: | Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6 – 2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding. Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection.Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of delayed post-polypectomy bleeding. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of patients before and after instruction were compared. Univariate analysis and forward stepwise logistic regression analysis were performed to test the influence of factors in association with delayed post-polypectomy bleeding.Results: A total of 3318 polyps in 1002 patients were evaluated. The before-instruction group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. Polyp size, pedunculated type, polyp location, and rate of cold snare polypectomy did not differ between before and after instruction. Clip placement was significantly more common after instruction (22.6%, 416/1839) than before (9.7%, 144/1479, P < 0.01). Delayed post-polypectomy bleeding occurred in 1.1% of cases before instruction, and 0.4% after instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Multivariate logistic regression analysis showed that hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for delayed post-polypectomy bleeding even after instruction.Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy. |
| Databáze: | OpenAIRE |
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