A risk-scoring model for the prediction of delayed bleeding after colorectal endoscopic submucosal dissection.

Abstract

BACKGROUND AND AIMS:

Delayed bleeding is an important adverse event after colorectal endoscopic submucosal dissection (ESD). We aimed to investigate the incidence and risk factors of delayed bleeding after colorectal ESD and to develop a risk-scoring model for predicting delayed bleeding.

METHODS:

This retrospective study was performed at 5 centers. The derivation and validation cohorts comprised 1189 patients from 1 center and 415 patients from the other 4 centers. We investigated the incidence and risk factors of delayed bleeding. Then, we developed a risk-scoring model for predicting delayed bleeding by using the data of the derivation cohort. We validated the scoring system in the validation cohort.

RESULTS:

Delayed bleeding occurred in 34 patients (2.9%) in the derivation cohort. In multivariate analysis, the risk factors of delayed bleeding were tumor location in the rectosigmoid colon (odds ratio [OR], 6.49; 95% confidence interval [CI], 1.96-21.42; P = .002), large tumor (≥30 mm) (OR, 2.10; 95% CI, 1.01-4.40; P = .048), and use of antiplatelet agents except for aspirin alone (OR, 4.04; 95% CI, 1.44-11.30; P = .008). These 3 factors were incorporated into a risk-scoring model for prediction of delayed bleeding. As the score based on this system increased, the incidence of delayed bleeding increased in the validation cohort.

CONCLUSION:

The risk-scoring model incorporating tumor location, tumor size, and use of antiplatelet agents can quantitatively predict the risk of delayed bleeding after colorectal ESD.

• Authors: Myeongsook Seo, Eun Mi Song, Jin Woong Cho, Young Jae Lee, Bo-In Lee, Jin Su Kim, Seong Woo Jeon, Hyun Joo Jang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 89 Issue 5 Pg. 990-998.e2 (05 2019) ISSN: 1097-6779 [Electronic] United States
• PMID: 30521794 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2019 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Topics

• Age Factors
• Aged
• Cohort Studies
• Colorectal Neoplasms (pathology, surgery)
• Endoscopic Mucosal Resection (adverse effects, methods)
• Female
• Follow-Up Studies
• Gastrointestinal Hemorrhage (epidemiology, etiology, physiopathology)
• Humans
• Incidence
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Postoperative Hemorrhage (diagnosis, epidemiology)
• Predictive Value of Tests
• Republic of Korea
• Retrospective Studies
• Risk Assessment
• Sex Factors
• Time Factors