Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

Bendall, Oliver; Ja, James; Pawlak, Katarzyna M.; Ishaq, Sauid; Tau, Jianhua A.; Suzuki, Noriko; Bollipo, Steven; Siau, Keith

doi:10.2147/ceg.s282699

Cited by 9 publications

(6 citation statements)

References 100 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is important because the risk of PPB is significantly increased as resection depth increases due to the exposed deep submucosal arteries. 28 Thus, the bleeding risk remained the same for both snare types.…”

Section: Discussionmentioning

confidence: 87%

Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis

et al. 2022

View full text Add to dashboard Cite

Background/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin-and thick-wire snares for CSP. Methods: A comprehensive search of the literature published between 2000 and October 2021 was performed of various databases for comparative studies evaluating the outcomes of thin-versus thick-wire snares for CSP. Results: Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97-1.09), overall bleeding (RR, 0.98; 95% CI, 0.40-2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97-1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72-2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis. Conclusions: CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.

show abstract

Section: Discussionmentioning

confidence: 87%

Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…These substances have the potential to dissolve blood clots that cover the surface of wounded ulcers, thereby leading to postoperative bleeding. [30] Pedunculated polyps (OR = 4.758, 95% CI = 1.322-17.129) were an independent risk factor for postoperative bleeding in patients with colorectal polyps (P < .05), suggesting that pedunculated polyps had an increased risk up to 4.758 times of bleeding after surgery compared with sessile polyps. This increased risk may be attributed to the abundant blood supply at the base of pedunculated polyps and their tendency for premature shedding, particularly following certain Endoscopic Variceal Ligation (EVL) procedures.…”

Section: Discussionmentioning

confidence: 95%

“…These substances have the potential to dissolve blood clots that cover the surface of wounded ulcers, thereby leading to postoperative bleeding. [ 30 ]…”

Section: Discussionmentioning

confidence: 99%

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

Li,

Yu,

Wang

et al. 2023

Medicine

View full text Add to dashboard Cite

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.

show abstract

“…According to a study, the risk of significantly delayed bleeding with conventional EMR has an odds ratio of 2.02 (1.30-3.14, P < 0.01). 24 Post-polypectomy bleeding can occur up to 30 days from the time of the procedure in some cases. 25 CS-EMR mitigates this risk by not creating an eschar in the first place.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Cold Snare Endoscopic Mucosal Resection (CS-EMR) for Nonampullary Duodenal Polyps

Mohamed,

Ahmed,

Rajadurai

et al. 2023

Journal of Clinical Gastroenterology

View full text Add to dashboard Cite

Introduction: There is an increasing interest in cold snare endoscopic mucosal resection (CS-EMR), and studies have shown its safety and efficacy for colonic polyps. This meta-analysis aims to assess the safety and efficacy of CS-EMR for the removal of duodenal adenomas. Methods: We conducted a comprehensive literature search of several databases, from inception through February 2023, for studies that addressed outcomes of CS-EMR for nonampullary duodenal adenomas. We used the random-effects model for the statistical analysis. The weighted pooled rates were used to summarize the technical success, polyp recurrence, bleeding, and perforation events. Cochran Q test and I 2 statistics adjudicated heterogeneity. Results: Six studies were included in the analysis. In all, 178 duodenal polyps were resected using CS-EMR. The pooled rates were 95.8% (95% CI 89.1–98.5%, I 2=21.5%) for technical success and 21.2% (95% CI 8.5–43.6%, I 2=78%) for polyp recurrence. With regards to CS-EMR safety, the pooled rates were 4.2% (95% CI 1.6–10.5%, I 2=12%) for immediate bleeding, 3.4% (95% CI 1.5–7.6%, I 2=0%) for delayed bleeding, 2.8% (95% CI 1.1–6.7%, I 2=0%) for perforation, and 2% (95% CL 0.5–7.5%, I 2=0%) for post-polypectomy syndrome. Rates were not significantly different for large adenomas. Three studies reported data on CS-EMR and conventional EMR. Compared with conventional EMR, CS-EMR had lower odds of delayed bleeding, OR 0.11 (CI 0.02–0.62, P value 0.012, I 2=0%). Conclusion: Our findings suggest that CS-EMR is a safe and effective strategy for the resection of nonampullary duodenal adenomas, with an acceptable recurrence rate. Data from larger randomized controlled studies are needed to validate our findings.

show abstract

Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

Cited by 9 publications

References 100 publications

Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis

Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis

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

Efficacy and Safety of Cold Snare Endoscopic Mucosal Resection (CS-EMR) for Nonampullary Duodenal Polyps

Contact Info

Product

Resources

About