Endoscopic Management of Post-Polypectomy Bleeding

Gutta, Aditya; Gromski, Mark A.

doi:10.5946/ce.2019.062

Cited by 31 publications

(28 citation statements)

References 84 publications

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“…The results of our pilot study demonstrated that prophylactic APC was not effective in preventing or reducing delayed post‐papillectomy bleeding. This result is contrary to our initial expectations and other previous studies that showed favorable results demonstrating the beneficial effects of APC 17–24 . Since its initial clinical application to flexible gastrointestinal endoscopes in 1991, 25 APC has gained popularity because of its noncontact nature, relative safety, tolerability, and effectiveness in endoscopically controlling nonvariceal bleeding.…”

Section: Discussioncontrasting

confidence: 92%

“…Since its initial clinical application to flexible gastrointestinal endoscopes in 1991, 25 APC has gained popularity because of its noncontact nature, relative safety, tolerability, and effectiveness in endoscopically controlling nonvariceal bleeding. APC is now considered the treatment of choice for bleeding or symptomatic vascular malformations, such as angiodysplasia, gastric vascular ectasia, Dieulafoy's lesions and chronic radiation proctopathy 17–20 . Furthermore, APC has shown efficacy to similar heater probes in initial hemostasis and the prevention of recurrent bleeding when treating major peptic ulcer bleeding endoscopically 21,22 .…”

Section: Discussionmentioning

confidence: 99%

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Can prophylactic argon plasma coagulation reduce delayed post‐papillectomy bleeding? A prospective multicenter trial

Yang

Hyun

Lee

et al. 2020

J of Gastro and Hepatol

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Background and Aim Endoscopic post‐papillectomy bleeding occurs in 3% to 20% of the cases, and delayed bleeding is also problematic. However, there is no consensus on how to reduce delayed post‐papillectomy bleeding. The aim of this study was to evaluate the efficacy of prophylactic argon plasma coagulation (APC) to minimize delayed bleeding and reduce the persistence of residual tumors after endoscopic papillectomy. Methods In a prospective pilot study of patients with benign ampullary tumors, the prophylactic APC group underwent APC at the resection margin following a conventional snaring papillectomy. Then, 24 h later after the papillectomy, all patients underwent a follow‐up duodenoscopy to identify post‐papillectomy bleeding and were followed up until 12 months. The main outcomes were the delayed (≥24 h) post‐papillectomy bleeding rate and the tumor persistence rate. Results The delayed post‐papillectomy bleeding rate was 30.8% (8/26) in the prophylactic APC group and 21.4% (6/28) in the non‐APC group (P = 0.434). The post‐procedure pancreatitis rates were 23.1% (6/26) and 35.7% (10/28), respectively (P = 0.310). The rate of tumor persistence did not differ between the two groups at 1 month (12.5% vs 7.4%, P = 0.656), 3 months (4.2% vs 3.7%, P = 1.00), 6 months (8.3% vs 3.7%, P = 0.595), and 12 months (0% vs 3.7%, P = 1.00). There were no procedure‐related mortalities or serious complications. Conclusion Prophylactic APC may not be effective in reducing delayed post‐papillectomy bleeding or remnant tumor ablation immediately after conventional papillectomy (Clinical trial registration—http://cris.nih.go.kr; KCT0001955).

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Can prophylactic argon plasma coagulation reduce delayed post‐papillectomy bleeding? A prospective multicenter trial

Yang

Hyun

Lee

et al. 2020

J of Gastro and Hepatol

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“…The modality used most often to treat delayed post-polypectomy bleeding is through-the-scope clips; however, the use of novel modalities, such as topical hemostatic agents and capmounted clips, has also been reported [113]. Through-thescope clips achieve successful hemostasis in most patients, but evidence is based on clinical experience [113][114][115]. Treatment using bipolar coagulation, and non-contact coagulation therapy with APC have also been reported [116].…”

Section: Delayed Post-polypectomy Bleedingmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends that the initial assessment of patients presenting with acute lower gastrointestinal bleeding should include: a history of co-morbidities and medications that promote bleeding; hemodynamic parameters; physical examination (including digital rectal examination); and laboratory markers. A risk score can be used to aid, but should not replace, clinician judgment.Strong recommendation, low quality evidence. 2 ESGE recommends that, in patients presenting with a self-limited bleed and no adverse clinical features, an Oakland score of ≤ 8 points can be used to guide the clinician decision to discharge the patient for outpatient investigation.Strong recommendation, moderate quality evidence. 3 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and no history of cardiovascular disease, a restrictive red blood cell transfusion strategy, with a hemoglobin threshold of ≤ 7 g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of 7–9 g/dL is desirable.Strong recommendation, low quality evidence. 4 ESGE recommends, in hemodynamically stable patients with acute lower gastrointestinal bleeding and a history of acute or chronic cardiovascular disease, a more liberal red blood cell transfusion strategy, with a hemoglobin threshold of ≤ 8 g/dL prompting red blood cell transfusion. A post-transfusion target hemoglobin concentration of ≥ 10 g/dL is desirable.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients with major acute lower gastrointestinal bleeding, colonoscopy should be performed sometime during their hospital stay because there is no high quality evidence that early colonoscopy influences patient outcomes.Strong recommendation, low quality of evidence. 6 ESGE recommends that patients with hemodynamic instability and suspected ongoing bleeding undergo computed tomography angiography before endoscopic or radiologic treatment to locate the site of bleeding.Strong recommendation, low quality evidence. 7 ESGE recommends withholding vitamin K antagonists in patients with major lower gastrointestinal bleeding and correcting their coagulopathy according to the severity of bleeding and their thrombotic risk. In patients with hemodynamic instability, we recommend administering intravenous vitamin K and four-factor prothrombin complex concentrate (PCC), or fresh frozen plasma if PCC is not available.Strong recommendation, low quality evidence. 8 ESGE recommends temporarily withholding direct oral anticoagulants at presentation in patients with major lower gastrointestinal bleeding.Strong recommendation, low quality evidence. 9 ESGE does not recommend withholding aspirin in patients taking low dose aspirin for secondary cardiovascular prevention. If withheld, low dose aspirin should be resumed, preferably within 5 days or even earlier if hemostasis is achieved or there is no further evidence of bleeding.Strong recommendation, moderate quality evidence. 10 ESGE does not recommend routinely discontinuing dual antiplatelet therapy (low dose aspirin and a P2Y12 receptor antagonist) before cardiology consultation. Continuation of the aspirin is recommended, whereas the P2Y12 receptor antagonist can be continued or temporarily interrupted according to the severity of bleeding and the ischemic risk. If interrupted, the P2Y12 receptor antagonist should be restarted within 5 days, if still indicated.Strong recommendation, low quality evidence.

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“…The tube is pulled out when the drainage fluid is less than 5 ml in 24 h after the operation. There are also some other measures that can be taken to stop the bleeding such as spraying cold saline or hemostatic agent locally [31]. In summary, surgeons should use these kinds of hemostasis flexibly according to the actual situation of operation and their personal experience.…”

Section: Discussionmentioning

confidence: 99%

Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in vitro experiment

Sun

Wu³

et al. 2020

J Orthop Surg Res

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Purpose: The purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic lumbar discectomy (PELD). Methods: Clinical research and in vitro experiment are combined. In the in vitro experiment, 2.0-ml blood was diluted in different ratio to simulate the rinse solution of PELD, the hematocrit method (HCT-M) and red blood cell count method (RBC-M) were came up to estimate blood loss and the new methods were calibrated with the direct measurement method (Direct-M). In clinical research, 74 patients with L5/S1 disk herniation were treated with PELD, and HCT-M and the empirical method (EMP-M) were used to estimate the blood loss under endoscope. According to blood loss, all patients were divided into group A (≤ 10 ml) and group B (> 10 ml). The blood loss, operation time, fluoroscopy frequency, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores were compared between the two groups. Results: In the in vitro experiment, the hematocrit of the rinse solution was always stable over time. The estimated blood loss by HCT-M was stable and quite approximate to actual blood volume (2.0 ml) whatever the blood dilution ratio, while according to RBC-M, the estimated blood loss was close to the actual blood volume only when the dilution ratio was greater than 300 times. In clinical research, the blood loss estimated by HCT-M was higher than that by EMP-M in both groups (P < 0.05). There was a significant difference between group A and group B in blood loss (7.40 ± 1.61 vs 19.91 ± 10.94 ml), operation time (80.51 ± 34.70 vs 136.51 ± 41.88 min), and fluoroscopy frequency (6.92 ± 1.52 vs 11.11 ± 2.32 times) (P < 0.05). The VAS and ODI scores in group B were higher than that in group A 1 week after operation (P < 0.05); however, the scores were not different between the two groups at pre-operation (P > 0.05).

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Endoscopic Management of Post-Polypectomy Bleeding

Cited by 31 publications

References 84 publications

Can prophylactic argon plasma coagulation reduce delayed post‐papillectomy bleeding? A prospective multicenter trial

Can prophylactic argon plasma coagulation reduce delayed post‐papillectomy bleeding? A prospective multicenter trial

Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in vitro experiment

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