Effectiveness of prophylactic clipping in preventing postpolypectomy bleeding in aspirin users: a propensity-score analysis

Effectiveness of nasogastric tube decompression in mitigating delayed bleeding following endoscopic submucosal dissection for early gastric cancers

BACKGROUND AND AIMS

Nasogastric tube decompression (NGTD) has been a standard practice following endoscopic submucosal dissection (ESD) for early gastric cancers (EGCs) in clinical settings for several years. Nevertheless, there remains a dearth of research assessing the efficacy of NGTD in preventing delayed bleeding after ESD.

METHODS

From January 2021 to December 2022, eligible patients who underwent gastric ESD for EGCs were categorized into two groups: NGTD group and no NGTD group. A retrospective Propensity Score Matching (PSM) study was performed to analyzed the data.

RESULTS

The delayed bleeding rate did not exhibit a significant decrease in the NGTD group, when compared with the no NGTD group. In the multivariate analysis, the size of the resected lesion emerged as the sole predictive factor for delayed bleeding after ESD, as opposed to the use of NGTD. Moreover, our findings revealed that hospital stay and costs were higher in the NGTD group. (8 days vs 7 days, p = 0.033, 3348.19$ vs 2840.28$, p = 0.00, respectively).

CONCLUSION

The utilization of NGTD showed no significant impact on delayed bleeding after ESD for EGCs and was correlated with hospital stay and costs. Therefore, the routine application of NGTD following ESD for EGCs may not be deemed necessary.

Clinical Trial: Precise Administration of Sucralfate Powder in Prevention of Delayed Postpolypectomy Bleeding. A Randomized Controlled Trial

INTRODUCTION

Delayed postpolypectomy bleeding occurs in approximately 1%-2% of all patients undergoing colonoscopic polypectomy, and this rate increases to 6% in patients with large (>2 cm) colon polyps. Sucralfate can protect the mucosa and promote its healing. This study was conducted to investigate whether colonoscopic spraying of sucralfate powder on polypectomy wounds can prevent delayed postoperative bleeding.

METHODS

This randomized controlled trial included patients with polyps (size ≥0.5 cm) who had undergone colonoscopic polypectomy at our hospital between May 2023 and January 2024. After polypectomy, the patients received standard treatment for immediate bleeding. Then, they were randomly allocated to either a sucralfate group (prophylactic spraying of sucralfate powder [3 g] on polypectomy wounds) or a control group. All patients were monitored for delayed bleeding within 28 days after colonoscopy.

RESULTS

A total of 160 patients were divided into the sucralfate and control groups (80 per group). The baseline characteristics were balanced between the groups. The rate of delayed postpolypectomy bleeding (0% vs 6.3%, respectively; P = 0.029) and postpolypectomy overt bloody stool (2.4% vs 18.8%, respectively; P = 0.001) were lower in the sucralfate group than in the control group. The duration of freedom from delayed bleeding was longer in the sucralfate group than in the control group ( P = 0.024). Multivariate Cox regression analysis confirmed the additional sucralfate spray as an independent factor against postpolypectomy overt bloody stool (relative risk, 0.03; 95% confidence interval, 0.003-0.43; P = 0.009).

DISCUSSION

Colonoscopic spraying of sucralfate powder is a safe approach with potential to reduce the risk of delayed postpolypectomy bleeding. Trial registration: NCT05817656.

Establishing a nomogram for predicting the risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal tumors

BACKGROUND

The aim of this study is to establish a nomogram that can predict the risk factors for delayed bleeding after endoscopic submucosal dissection (ESD). This model can be used to assess the probability of delayed bleeding before ESD surgery, thereby avoiding wasting medical resources and improving patient satisfaction.

METHODS

This was a retrospective study in which all patients underwent ESD surgery for colorectal tumors between August 2021 and February 2024. Patient demographics and surgical characteristics were collected. All patients were randomly divided into a training set and a testing set. Univariate and multivariate regression analyses of the training set revealed the independent risk factors for delayed bleeding after ESD. These independent risk factors were used to construct a nomogram model. This model was validated using internal validation methods such as the C-index, calibration curve, and decision curve analysis.

RESULTS

This study included 587 patients. The occurrence rate of delayed bleeding after ESD in the training set was 8.98%. Multivariate regression analysis revealed that the location of the lesion in the rectum, a large lesion, and a prolonged surgery time were independent risk factors for delayed bleeding after ESD. The C-index for this model was 0.89, and validation of this nomogram model demonstrated good consistency between the predicted and actual values.

CONCLUSION

Multivariate regression analysis revealed the independent risk factors for delayed bleeding after ESD, and a nomogram with a relatively consistent accuracy was established. The clinical application of this model can reduce the incidence of delayed bleeding and therefore improve patient healing.

Safety of cold snare resection techniques for removal of polyps in the small colon in patients taking clopidogrel and aspirin: a Korean Association for the Study of Intestinal Diseases prospective multicenter study

BACKGROUND AND AIMS

Polypectomy is a procedure associated with a high risk of bleeding. Guidelines recommend uninterrupted aspirin use during polypectomy, whereas cessation of clopidogrel 5 to 7 days before polypectomy is recommended. The cold snare resection (CSR) technique, with or without submucosal injection, is considered safer than conventional polypectomy using electrocoagulation for postpolypectomy bleeding. In this study, we compared the bleeding adverse events associated with CSR between clopidogrel and aspirin users.

METHODS

This multicenter prospective cohort study was conducted in 5 academic hospitals in Korea and included clopidogrel and aspirin users who underwent polypectomy. Antiplatelet agents were used without interruption, with ≤3 days of interruption defined as continuous use. The primary endpoint was delayed bleeding, which was defined as bleeding occurring several hours after polypectomy, whereas immediate bleeding was defined as bleeding requiring hemostasis 2 minutes after polypectomy. Risk factors for immediate bleeding were investigated for each polyp.

RESULTS

Among the 263 patients (clopidogrel, 129; aspirin, 134), 509 underwent polypectomies. The rates of delayed bleeding per patient in the clopidogrel and aspirin groups were .8% and .7%, respectively, meeting noninferiority (rate difference, .03%; 95% confidence interval, -2.07 to 2.13). Hemostasis was achieved in 100 patients who underwent polypectomy (19.8%). Immediate bleeding risk factors were female sex, end-stage renal disease, submucosal injection before resection, and polyp size ≥5 mm.

CONCLUSIONS

This multicenter prospective study demonstrated the safety of CSR in patients treated with uninterrupted clopidogrel and aspirin. (Clinical trial registration number: NCT04328987.).

Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon

Post-polypectomy bleeding (PPB) remains a significant procedure-related complication, with multiple risk factors determining the risk including patient demographics, polyp characteristics, endoscopist expertise, and techniques of polypectomy. Immediate PPB is usually treated promptly, but management of delayed PPB can be challenging. Cold snare polypectomy is the optimal technique for small sessile polyps with hot snare polypectomy for pedunculated and large sessile polyps. Topical hemostatic powders and gels are being investigated for the prevention and management of PPB. Further studies are needed to compare these topical agents with conventional therapy.