A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
Por:
Albeniz, E, Fraile, M, Ibanez, B, Alonso-Aguirre, P, Martinez-Ares, D, Soto, S, Gargallo, CJ, Zabala, FR, Alvarez, MA, Rodriguez-Sanchez, J, Mugica, F, Nogales, O, de Tejada, AH, Redondo, E, Guarner-Argente, C, Pin, N, Leon-Brito, H, Pardeiro, R, Lopez-Roses, L, Rodriguez-Tellez, M, Jimenez, A, Martinez-Alcala, F, Garcia, O, de la Pena, J, Ono, A, de las Parras, F, Pellise, M, Rivero, L, Saperas, E, Perez-Roldan, F, Royo, AP, Ros, JE, Ripa, AZ, Concepcion-Martin, M, Huelin-Alvarez, P, Colan-Hernandez, J, Cubiella, J, Remedios, D, Caserras, XBI, Lopez-Viedma, B, Cobian, J, Gonzalez-Haba, M, Santiago, J, Martinez-Cara, JG, Valdivielso, E
Publicada:
1 ago 2016
Resumen:
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 beta 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.
Filiaciones:
Albeniz, E:
Complejo Hosp Navarra, Pamplona, Spain
Fraile, M:
Complejo Hosp Navarra, Pamplona, Spain
Ibanez, B:
Invest Serv Salud Enfermedades Cron, NavarraBiomed Fdn Miguel Servet & Red, Pamplona, Spain
Alonso-Aguirre, P:
Hosp Juan Canalejo, La Coruna, Spain
Martinez-Ares, D:
Complejo Hosp Vigo, Vigo, Spain
Soto, S:
Complejo Hosp Ourense, Orense, Spain
Gargallo, CJ:
Hosp Clin Univ Lozano Blesa, Zaragoza, Spain
Zabala, FR:
Hosp Univ HM Monteprincipe, Madrid, Spain
Ctr Andaluz Gastroenterol Integral, Seville, Spain
Alvarez, MA:
Hosp Mar, Barcelona, Spain
Rodriguez-Sanchez, J:
Hosp Gen Ciudad Real, Ciudad Real, Spain
Mugica, F:
Hosp Univ Donostia, Donostia San Sebastian, Spain
Nogales, O:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
de Tejada, AH:
Hosp Univ Puerta de Hierro, Madrid, Spain
Redondo, E:
Hosp Univ Virgen de las Nieves, Granada, Spain
Guarner-Argente, C:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Barcelona, Spain
Pin, N:
Hosp Juan Canalejo, La Coruna, Spain
Leon-Brito, H:
Complejo Hosp Navarra, Pamplona, Spain
Pardeiro, R:
Hosp Juan Canalejo, La Coruna, Spain
Lopez-Roses, L:
Hosp Univ Lucus Augusti, Lugo, Spain
Rodriguez-Tellez, M:
Hosp Univ Virgen Macarena, Seville, Spain
Jimenez, A:
Hosp Univ Virgen Macarena, Seville, Spain
Martinez-Alcala, F:
Ctr Andaluz Gastroenterol Integral, Seville, Spain
Garcia, O:
Hosp Moises Broggi, St Joan Desp, Spain
de la Pena, J:
Hosp Valdecilla, Santander, Spain
Ono, A:
Hosp Univ Virgen de la Arrixaca, Murcia, Spain
de las Parras, F:
Hosp Univ Virgen de la Arrixaca, Murcia, Spain
Pellise, M:
Hosp Clin Barcelona, Barcelona, Spain
Rivero, L:
Hosp Clin Barcelona, Barcelona, Spain
Saperas, E:
Hosp Gen Cataluna, Barcelona, Spain
Perez-Roldan, F:
Complejo Hosp Mancha Ctr, Ciudad Real, Spain
Royo, AP:
Complejo Hosp Navarra, Pamplona, Spain
Ros, JE:
Complejo Hosp Navarra, Pamplona, Spain
Ripa, AZ:
Complejo Hosp Navarra, Pamplona, Spain
Concepcion-Martin, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Barcelona, Spain
Huelin-Alvarez, P:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Barcelona, Spain
Colan-Hernandez, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Barcelona, Spain
Cubiella, J:
Complejo Hosp Ourense, Orense, Spain
Remedios, D:
Complejo Hosp Ourense, Orense, Spain
Caserras, XBI:
Hosp Mar, Barcelona, Spain
Lopez-Viedma, B:
Hosp Gen Ciudad Real, Ciudad Real, Spain
Cobian, J:
Hosp Univ Donostia, Donostia San Sebastian, Spain
Gonzalez-Haba, M:
Hosp Univ Puerta de Hierro, Madrid, Spain
Santiago, J:
Hosp Univ Puerta de Hierro, Madrid, Spain
Martinez-Cara, JG:
Hosp Univ Virgen de las Nieves, Granada, Spain
Valdivielso, E:
Hosp Juan Canalejo, La Coruna, Spain
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