Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Abstract

Patients at elevated risk of CSPEB can be identified using four readily available variables. This knowledge may improve the management of those undergoing WF-EMR and assist in designing studies evaluating CSPEB.

Clip Closure After Resection of Large Colorectal Lesions With Substantial Risk of Bleeding

“…Failed closure occurred in the remaining 18 (15%) patients. Median number of clips necessary for complete closure was 6 (range, [3][4][5][6][7][8][9][10][11][12][13]. Comparing the baseline characteristics between the control group and complete closure subgroup, there were more patients aged 75 years and older and the polyps were smaller in the complete closure subgroup (data not shown).…”

“…13 Adrenaline was not used in the injection solution in any case due to its possible involvement in DB. 6 Erbe models (Electromedizin ICC200, VIO-200, or VIO-300; Erbe, Tübingen, Germany) were used in the automatic controlled mode (Endocut-Q). Coagulation of submucosal vessels by means of snare-tip coagulation, argon plasma coagulation, or coagulation forceps was performed when the endoscopist considered it necessary.…”

“…[1][2][3][4][5] DB risk has been associated with proximal polyp location, large lesions, major comorbidities, antiplatelet treatment, and patient age. 3,6 Closure of a mucosal defect with clips after resection has long been considered to reduce the risk of bleeding. Although the application of clips after EMR is increasing, there is scarce evidence to support this practice.…”

Dilemma of colonoscopic polypectomy

“…The probabilities of clinically significant postprocedural bleeding in those with low (score 0‐1), medium (score 2‐4), and elevated (score 5‐6) risk levels were 1.7%, 7.1%, and 17.5% in the training cohort and 3.4%, 6.2%, and 15.7% in the test cohort, respectively. Further research regarding prophylactic therapies in high‐risk group is required . In editor's practice, high risk of PPB was selected by “5 seconds” reminder for clip prophylaxis—stalk size (>10 mm), shape (sessile), site (right‐sided), surface (villous architecture, HGD, or carcinoma suspected by mucosal pattern), and situation (antithrombotic therapy, old age, uremia, decompensated cirrhosis, bleeding disorder, etc.).…”

“…Further research regarding prophylactic therapies in high-risk group is required. 15 In editor's practice, high risk of PPB was selected by "5 seconds" reminder for clip prophylaxisstalk size (>10 mm), shape (sessile), site (right-sided), surface (villous architecture, HGD, or carcinoma suspected by mucosal pattern), and situation (antithrombotic therapy, old age, uremia, decompensated cirrhosis, bleeding disorder, etc.). By this simple reminder, we may effectively select lesions for PPB prophylaxis.…”