Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps

Abstract

This study aimed to assess the effectiveness of Endoscopic Mucosal Resection (EMR) and Argon Plasma Coagulation (APC) as therapeutic approaches for intestinal polyps in patients, and to examine the factors associated with postoperative bleeding. This study included 132 patients diagnosed with colorectal polyps (188 polyps) who underwent endoscopic surgery at our hospital between January 2022 and December 2022. Based on the surgical method employed, the patients were divided into 2 groups: EMR (68 cases, 97 polyps) and APC (64 cases, 91 polyps). Comparative analyses were conducted to assess the clinical efficacy, surgery-related indicators, and quality of life the 2 groups. Furthermore, an investigation was carried out to identify the factors associated with postoperative bleeding. The analysis revealed no statistically significant difference in the cure rate of flat and superficial raised polyps between the EMR group and the APC (P > .05). However, it was found that the EMR group exhibited a significantly higher cure rate for subpedunculated and raised-pedunculated polyps compared to the APC group (P < .05). The results of logistics analysis showed that patients with hypertension (OR = 2.876, 95% CI: 1.119–7.393), patients with diabetes (OR = 5.278, 95% CI: 1.388–20.064), patients with hyperlipidemia (OR = 2.594, 95% CI: 1.054–6.380), the polyps of right hemicolon (OR = 2.743, 95% CI: 1.003–7.504), rectal polyps (OR = 5.143, 95% CI: 1.728–7.504), pedunculated polyps (OR = 4.758, 95% CI: 1.322–17.129), adenomatous polyps (OR = 3.152, 95% CI: 1.018–9.757) were independent risk factors for postoperative bleeding in patients with colorectal polyps (P < .05). The findings suggest that for subpedunculated and pedunculated-raised polyps, EMR can be a suitable treatment approach. On the other hand, flat and superficial-raised polyps can be effectively managed with either EMR or APC. The presence of hypertension, diabetes, hyperlipidemia, polyps of the right hemicolon, rectal polyps, pedunculated polyps, and adenomatous polyps has been established as independent risk factors for postoperative bleeding in patients with colorectal polyps.

Risk factors for delayed colorectal postpolypectomy bleeding: a meta-analysis

“…A total of 6 studies scored 6 stars [ 6 , 13 – 17 ], 7 studies scored 7 stars [ 3 , 7 , 8 , 18 – 21 ], and 2 studies scored 8 stars [ 22 , 23 ] (Table 1 ).…”

“…Thirteen studies [ 3 , 6 – 8 , 13 – 20 , 22 ] have examined the incidence of DPPB (i.e., the number of DPPB cases/total number of cases), with I 2 = 98%. The random effects model was used for pooled analysis, and the incidence of DPPB was 0.02, 95% CI (0.01–0.03).…”

“…The exclusion criteria were as follows: [ 1 ] the research content did not involve or was not related to the risk factors for delayed bleeding after colorectal polypectomy; [ 2 ] duplicate publications repeatedly; [ 3 ] animal experiments, reviews, case reports, conference abstracts, dissertations; [ 4 ] studies without a control group; [ 5 ] the same researcher published similar documents; and [ 6 ] documents with incomplete data, unclear description, unavailable data, and limited research group.…”

“…The researchers screened the titles, abstracts, and full texts in accordance with the inclusion and exclusion criteria, and the data were extracted into an Excel spreadsheet. The extracted data included [ 1 ] general data, including first author’s name, year of publication, and type of study; [ 2 ] baseline data, including sample size, sex, and age; [ 3 ] patient factors; [ 4 ] polyp factors, including polyp number, polyp diameter, polyp shape, polyp location, and polyp pathological type; [ 5 ] operation factors; and [ 6 ] the same effect size and 95% confidence interval (CI) were obtained by multivariate regression analysis. Any disagreement was resolved through discussion, consultation with a third researcher (JX) if necessary, and discussion or arbitration.…”

“…There are different reports in the literature on factors related to DPPB. Some studies have shown that the incidence of DPPB is higher among patients receiving anticoagulant therapy [ 4 – 6 ]. Some studies also showed that the incidence of DPPB was positively correlated with the size of polyps removed [ 7 – 9 ].…”