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Observational Study
. 2016 Aug;14(8):1140-7.
doi: 10.1016/j.cgh.2016.03.021. Epub 2016 Mar 24.

A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions

Eduardo Albéniz  1 , María Fraile  2 , Berta Ibáñez  3 , Pedro Alonso-Aguirre  4 , David Martínez-Ares  5 , Santiago Soto  6 , Carla Jerusalén Gargallo  7 , Felipe Ramos Zabala  8 , Marco Antonio Álvarez  9 , Joaquín Rodríguez-Sánchez  10 , Fernando Múgica  11 , Óscar Nogales  12 , Alberto Herreros de Tejada  13 , Eduardo Redondo  14 , Noel Pin  4 , Helena León-Brito  2 , Remedios Pardeiro  4 , Leopoldo López-Roses  15 , Manuel Rodríguez-Téllez  16 , Alejandra Jiménez  16 , Felipe Martínez-Alcalá  17 , Orlando García  18 , Joaquín de la Peña  19 , Akiko Ono  20 , Fernando Alberca de Las Parras  20 , María Pellisé  21 , Liseth Rivero  21 , Esteban Saperas  22 , Francisco Pérez-Roldán  23 , Antonio Pueyo Royo  2 , Javier Eguaras Ros  2 , Alba Zúñiga Ripa  2 , Mar Concepción-Martín  24 , Patricia Huelin-Álvarez  24 , Juan Colán-Hernández  24 , Joaquín Cubiella  6 , David Remedios  6 , Xavier Bessa I Caserras  9 , Bartolomé López-Viedma  10 , Julyssa Cobian  11 , Mariano González-Haba  13 , José Santiago  13 , Juan Gabriel Martínez-Cara  14 , Eduardo Valdivielso  4 , Carlos Guarner-Argente  24 ; Endoscopic Mucosal Resection Endoscopic Spanish Society Group
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Free article
Observational Study

A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions

Eduardo Albéniz et al. Clin Gastroenterol Hepatol. 2016 Aug.
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Clin Gastroenterol Hepatol. 2017 Mar;15(3):469. doi: 10.1016/j.cgh.2017.01.002. Epub 2017 Jan 12. Clin Gastroenterol Hepatol. 2017. PMID: 28088006 No abstract available.

Abstract

Background & aims: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk.

Methods: We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the β parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding.

Results: Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age ≥75 years (odds ratio [OR], 2.36; P < .01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P ≤ .05), aspirin use during EMR (OR, 3.16; P < .05), right-sided lesions (OR, 4.86; P < .01), lesion size ≥40 mm (OR, 1.91; P ≤ .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P ≤ .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively.

Conclusions: The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.

Keywords: ASA; Colon Cancer; Mucosectomy; Prognostic Factor.

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