Risk factors of post-polypectomy bleeding and recurrence in children with colorectal polyps after endoscopic mucosal resection: a retrospective cohort study

Abstract

Background: The incidence rate of colorectal polyps in children has gradually increased in recent years.It is still unclear whether endoscopic mucosal resection (EMR) can be performed in children with colorectal polyps as well as their incidences of post-polypectomy bleeding and recurrence. This retrospective study was performed to explore the feasible of EMR in children with colorectal polyps and analyze the risk factors of post-polypectomy bleeding and recurrence.Methods: Patients aged younger than 18 years diagnosed with colorectal polyps and received EMR for polypectomy between January 2017 and December 2021 were included in this study. The baseline data of included patients were retrospectively collected. All complications related to polypectomy were recorded during follow up via telephone, internet, or outpatient department, including post-polypectomy bleeding, perforation and polyp recurrence. Patients with and without post-polypectomy complications were divided into 2 groups.The risk factors of post-polypectomy bleeding and polyp recurrence were analyzed using multivariable logistic regression models after adjusting potential risk factors using univariable regression models.Results: A total of 589 patients were included in this retrospective study. There were 333 male patients and 256 female patients, and their average age was 4.4±1.9 years old. The average diameter of their polyps was 8.4±2.8 mm, and 542 (92.0%) polyps presented as pedunculated lesions. A total of 540 (91.7%) polyps were diagnosed as juvenile polyps and 509 (86.4%) patients had only 1 polyp. There were a total of 75 cases of post-polypectomy complications (12.7%). The most common complication was early post-polypectomy bleeding (5.3%), followed by polyp recurrence (3.7%). Post-polypectomy bleeding occurred the most on the third and fourth day after EMR polypectomy. Larger polyps (OR =1.742, P<0.001), sessile lesions (OR =3.150, P=0.019), and multiple polyps (OR =4.372, P=0.003) were identified to be related to the incidence of post-polypectomy bleeding. Besides, sessile lesions (OR =3.887, P=0.026) were identified as the main risk factor and older patients (OR =0.606, P=0.004) had lower potential for post-polypectomy recurrence.Conclusions: More attention should be paid to large, sessile, and multiple polyps during the procedure of EMR in children. The small number of patients in this study limits further analysis of results and a large sample study should be performed.

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

“…[31] It has also been suggested that pedunculated polyps usually have long, large-bore trophoblastic vessels within the peduncle, and that intraoperative exposure of blood vessels increases the risk of rebleeding and delayed bleeding. [32] In addition, adenomatous polyps (OR = 3.152, 95% CI = 1.018–9.757) are independent risk factors ( P < .05) for postoperative bleeding in patients with colorectal polyps, indicating that adenomatous polyps have an increased risk up to 3.152 times of bleeding after surgery compared with non-adenomatous polyps. This may be due to the fact that adenomatous polyps have a richer blood supply than other types of polyps, [33] which makes them more prone to postoperative bleeding.…”

“…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. [ 31 ] It has also been suggested that pedunculated polyps usually have long, large-bore trophoblastic vessels within the peduncle, and that intraoperative exposure of blood vessels increases the risk of rebleeding and delayed bleeding. [ 32 ] In addition, adenomatous polyps (OR = 3.152, 95% CI = 1.018–9.757) are independent risk factors ( P < .05) for postoperative bleeding in patients with colorectal polyps, indicating that adenomatous polyps have an increased risk up to 3.152 times of bleeding after surgery compared with non-adenomatous polyps.…”

Endoscopy in pediatric polyposis syndromes: why, when and how

“…Early postpolypectomy bleeding was noted in 5% of patients in one study and was more common in younger patients harboring larger polyps, more often with inflammatory polyp histology. Similarly, postpolypectomy recurrence was more often noted in younger patients with multiple and larger polyps [30].…”