Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps

Elliott, Timothy R.; Tsiamoulos, Zacharias P.; Thomas-Gibson, Siwan; Suzuki, Noriko; Bourikas, Leonidas A.; Hart, Ailsa; Bassett, Paul; Saunders, Brian P.

doi:10.1055/a-0577-3206

Cited by 19 publications

(18 citation statements)

References 23 publications

(30 reference statements)

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“…Focusing on postprocedural bleeding, rates ranging from 2.2% to 6.7% have been reported in the literature when using hot EMR for large polyps. 22,23 In our pooled analysis the postprocedural bleed rate was .5% for all polyps !10 mm and 0% when the analysis was restricted just to studies on EMR. Although randomized controlled trials would be required, if we do compare these results with previous meta-analyses on conventional polypectomy or EMR techniques, [24][25][26] CSP appears to be substantially safer.…”

Section: Discussionmentioning

confidence: 73%

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Chandrasekar

Spadaccini

Aziz

et al. 2019

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 73%

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Chandrasekar

Spadaccini

Aziz

et al. 2019

Gastrointestinal Endoscopy

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“…For EMR of small lesions (< 1 cm), however, PPB rates were similar to those reported following conventional polypectomy 78 . A retrospective cohort study did not find aspirin (continued till day of procedure) or P2Y12 receptor antagonists (stopped 5–7 days before EMR) to be significant factors associated with bleeding post EMR of colon neoplasia 79 . However only a small minority (aspirin 20 % and clopidogrel 2 %) of patients were taking these medications.…”

Section: Endoscopic Proceduresmentioning

confidence: 96%

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

et al. 2021

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This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

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“…Recently, Kim et al concluded that cut vessels and severe coagulation injury are predictive for DB [27]. Intact visible vessels are less clearly associated with DB-rate [28,29], but !3 visible vessels in the post-EMR defect have been suggested to also increase the risk of DB [30]. Although prophylactic coagulation of visible vessels does not decrease clinically significant DB after EMR, the effect of clipping is unknown [28,31].…”

Section: Risk Factors Vs Factors In Decision-makingmentioning

confidence: 99%

Factors involved in endoscopists’ choice for prophylactic clipping after colorectal endoscopic mucosal resection: a discrete choice experiment

Turan

Didden

Peters

et al. 2020

Scandinavian Journal of Gastroenterology

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Background: Delayed bleeding (DB) occurs in $10% after colorectal EMR. Prophylactic clipping (PC) was reported to significantly decrease DB-rate in proximal lesions !2 cm. Objective: Our aim was to determine which predefined variables contribute to using PC in clinical practice. Methods: We performed an international discrete choice experiment (DCE) among $500 endoscopists. Relevant variables for PC use were selected by EMR experts: previous DB, anticoagulants, polyp size, morphology, location, intraprocedural bleeding and visible vessel(s). Respondents answered case scenarios with various variable combinations, each time choosing only one scenario for PC, or the 'none' option. Part-worth utilities and importance weights were calculated using HB regression. Subsequently, a predictive model was created to calculate the likelihood of endoscopists choosing PC in any given case. Results: The survey was completed by 190 EMR endoscopists from 17 countries. In total, 8% would never use PC, whereas 30.9% never chose the 'none' option. All variables except polyp type were significant in decision-making for PC (p < .01). The most important factor was anticoagulant use, accounting for 22.5% in decision-making. Polyps <2 cm were considered eligible for PC by 14% in the presence of high-weighing factors such as anticoagulant use. No significant differences were found between high and low-to-moderately experienced endoscopists. Conclusions: PC after EMR is often considered useful by endoscopists, usually based on risk factors for DB. Anticoagulant use was the most important factor in decision-making for PC, independent of endoscopist experience. Although not considered cost-effective, one in seven endoscopists chose PC for adenomas <2 cm.

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Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps

Cited by 19 publications

References 23 publications

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Factors involved in endoscopists’ choice for prophylactic clipping after colorectal endoscopic mucosal resection: a discrete choice experiment

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