Establishment of a model for predicting delayed post-polypectomy bleeding: A real-world retrospective study

Abstract

BackgroundDelayed post-polypectomy bleeding (DPPB) is the most common complication which occurs within 30 days after polypectomy, it has become rather common with the widespread of colorectal cancer screening. It is important to clarified predictors of DPPB and identify patients at high risk.Materials and methodsThis was a real-world retrospective study based on medical records from The First Affiliated Hospital of Nanjing Medical University. Cases of patients who underwent colonoscopic polypectomy between January 2016 and December 2020 were reviewed to identify risk factors of DPPB. We use the LASSO-Logistic regression analysis model to identify independent predictors and create a predictive model. The model finally got visualized by developing a nomogram.ResultsColonoscopic polypectomy was done on 16,925 patients in our study. DPPB occurred in 125 (0.74%) of these instances. In multivariate analysis, age, sex, hypertension, polyp location, polyp size, and operative modality were found to be independent risk factors and were integrated for the construction of a nomogram. The model’s C-index is 0.801 (95%CI: 0.761–0.846). We also found polyps located at the right semicolon and polyp ≥ 1 cm associated with active bleeding under the therapeutic colonoscopy.ConclusionYoung age, male, hypertension, polyp ≥ 1 cm, proximal colon location and operative modality were finally identified as significant predictors of DPPB. We developed and validated a nomogram which performs well in predicting the incidence of DPPB, the model we established can be used as a valuable screening tool to identify patients who are at high risk of bleeding.

The Effectiveness of Prophylactic Epinephrine Compared to No Prophylaxis for Postpolypectomy Bleeding in Endoscopic Colorectal Surgery: A Systematic Review and Meta-Analysis

“…Our study aligns with previous research in terms of the effectiveness of prophylactic epinephrine in reducing early postpolypectomy bleeding [ 23 , 24 ]. However, it diverges regarding delayed bleeding outcomes, where our findings indicate a lack of significant impact, contrasting with previous reports [ 19 , 21 , 22 ].…”

“…Our study makes a significant contribution to the current understanding of postpolypectomy bleeding, a pivotal concern in gastrointestinal endoscopic procedures. We observed a postpolypectomy bleeding rate of 6.68%, notably surpassing the previously reported prevalence of 0.75% to 5% [19,20]. In our cohort, epinephrine administration significantly reduced early or immediate postpolypectomy bleeding to 3%, in contrast to 8.64% in the no-prophylaxis group.…”

“…In our cohort, epinephrine administration significantly reduced early or immediate postpolypectomy bleeding to 3%, in contrast to 8.64% in the no-prophylaxis group. This intervention did not show any effect on the incidence of delayed bleeding, which was 0.85%, exceeding the range of 0.14% to 0.74% noted in previous studies [ 19 , 21 , 22 ]. These findings offer nuanced insights into the differential impacts of prophylactic strategies during various postpolypectomy phases.…”

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

“…Vascular endothelial dysfunction in hypertensive disease, often accompanied by arteriosclerosis, is accompanied by fluctuating blood pressure and hemodynamic instability in hypertensive disease, which may lead to rupture of small blood vessels in the surface of a wound. [ 24 ] Vessels at the mucous membrane of large intestine in diabetic patients are brittle, and can easily result in bleeding and poor postoperative healing, [ 25 ] which is prone to delayed bleeding. This may be related to the factors such as microangiopathy, blood rheological changes, and the abnormalities of anticoagulant fibrinolytic system caused by diabetic metabolic disorders.…”