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Sun J, Xie X, Liu Y, Hao X, Yang G, Zhang D, Nan Q. Complications after endoscopic submucosal dissection for early colorectal cancer (Review). Oncol Lett 2023; 25:264. [PMID: 37216158 PMCID: PMC10193368 DOI: 10.3892/ol.2023.13850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Colorectal cancer (CRC) is a gastrointestinal malignancy that seriously threatens human life and health, resulting in a heavy disease burden. Endoscopic submucosal dissection (ESD) is widely used in clinical practice and is an effective treatment for early CRC (ECC). Colorectal ESD is a challenging operation, and the incidence of postoperative complications is relatively high because of the thin intestinal wall and limited space for endoscopic operations. Systematic reports on the postoperative complications of colorectal ESD, such as fever, bleeding and perforation, from both China and elsewhere are lacking. In the present review, progress in research on postoperative complications after ESD for ECC is summarized.
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Affiliation(s)
- Jianhui Sun
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Xinyuan Xie
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Yangcheng Liu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
| | - Xianglin Hao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Gang Yang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
| | - Dan Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Qiong Nan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
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Saito M, Yamamura T, Nakamura M, Maeda K, Sawada T, Ishikawa E, Mizutani Y, Ishikawa T, Kakushima N, Furukawa K, Ohno E, Kawashima H, Ishigami M, Fujishiro M. Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching. World J Gastroenterol 2021; 27:8182-8193. [PMID: 35068862 PMCID: PMC8704276 DOI: 10.3748/wjg.v27.i47.8182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/15/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cold polypectomy (CP) is a simple and safe procedure for polyps less than 10 mm in size; however, there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation. Some clinical trials have evaluated local persistent recurrence; their results suggest that a higher rate of local recurrence has not been documented so far. There were few reports that observed the course over long periods of time after CP in clinical practice.
AIM To evaluate the presence of local recurrence following CP and hot polypectomy (HP) using propensity score matching.
METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm (959 Lesions) between October 2016 and 2017 and underwent follow-up endoscopy subsequently. We divided them into the CP group (706 Lesions), wherein CP was performed, and the HP group (253 Lesions), wherein HP was performed. Using propensity score matching, we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.
RESULTS After propensity score matching, there were no significant differences in the patients’ and their endoscopic background (age, use of antithrombotics, indications, size, morphology, location of polyps, and polypectomy device) between the groups. The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5 ± 7.1 (range, 6-39) mo in the CP group and 15.7 ± 6.0 (range, 6-35) mo in the HP group, which was significantly longer in the CP group (P = 0.005). The local recurrence rate was 0.93% in the CP group and 0.93% in the HP group, without a significant difference (P = 0.688). Additionally, no differences were observed in the macroscopic en bloc resection rate, histopathological complete resection rate, and pathological results between the groups. Adverse events did not occur in either group.
CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice. CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.
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Affiliation(s)
- Masashi Saito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Keiko Maeda
- Department of Endoscopy, Nagoya University Hospital, Nagoya 4668550, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Nagoya 4668550, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Nagoya 4668550, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
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Liu C, Wu R, Sun X, Tao C, Liu Z. Risk factors for delayed hemorrhage after colonoscopic postpolypectomy: Polyp size and operative modality. JGH OPEN 2018; 3:61-64. [PMID: 30834342 PMCID: PMC6386734 DOI: 10.1002/jgh3.12106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 12/19/2022]
Abstract
Background and Aim Delayed postpolypectomy hemorrhage is relatively common, with occasional extensive blood loss, endangering life. This study aimed to determine the factors associated with postoperative hemorrhage. Methods The study was a retrospective cohort study of patients hospitalized for colonoscopic polypectomy at the Department of Gastroenterology and Hepatology, Tenth People's Hospital of Tongji University, China, between January and December 2015. Data on gender, age, bowel preparation, location, size, number of polyps, operative modality, pathology, and operation practitioner were collected. Patients were divided into two groups based on the presence or absence of postoperative hemorrhage. Results A total of 1962 polyps were detected in patients and they underwent polypectomy; hemorrhage occurred in 41 cases. A correlation was demonstrated between postpolypectomy hemorrhage and each of the following factors: polyp size and operative modality. The odds ratio (OR) was 4.535 (95% confidence interval [CI], 2.331–8.823) for 1–2‐cm polyps, 4.008 (95% CI, 0.904–17.776) for 2–3‐cm polyps, and 22.407 (95% CI, 5.783–86.812) for ≥3‐cm polyps. Compared with argon plasma coagulation, OR was 9.128 (95% CI, 3.548–23.486) for endoscopic mucosal resection and 31.257 (95% CI, 7.009–139.395) for endoscopic submucosal dissection. Conclusions The independent risk factors for delayed postpolypectomy hemorrhage include polyp size and operative modality.
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Affiliation(s)
- Changqin Liu
- Department of Gastroenterology and Hepatology Shanghai Tenth People's Hospital of TongJi University Shanghai China
| | - Ruijin Wu
- Department of Gastroenterology and Hepatology Shanghai Tenth People's Hospital of TongJi University Shanghai China
| | - Xiaomin Sun
- Department of Gastroenterology and Hepatology Shanghai Tenth People's Hospital of TongJi University Shanghai China
| | - Chunhua Tao
- Department of Gastroenterology and Hepatology Shanghai Tenth People's Hospital of TongJi University Shanghai China
| | - Zhanju Liu
- Department of Gastroenterology and Hepatology Shanghai Tenth People's Hospital of TongJi University Shanghai China
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Do We Perform a Perfect Endoscopic Hemostasis Prophylactically with Argon Plasma Coagulation in Colonic Endoscopic Mucosal Resection? Dig Dis Sci 2015; 60:3100-7. [PMID: 26065369 DOI: 10.1007/s10620-015-3725-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/15/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Submucosal injection for endoscopic mucosal resection (EMR) may effect performing the prophylactic argon plasma coagulation (APC) of non-bleeding visible vessels on ulcer crater. AIMS The purpose of this study was to evaluate the clinical features of visible vessels in iatrogenic ulcers over time after prophylactic APC in colonic EMR. PATIENTS AND METHODS This study was designed as a prospective study. Between August and November 2013, a total of 40 patients who were admitted underwent prophylactic APC for non-bleeding visible vessels after colonic EMR. After confirming whether visible vessels were completely coagulated or not, the number of visible vessels in ulcers was counted over a specific time period, e.g. 1, 3, 5, or 7 min. RESULTS The mean number of visible vessels was significantly higher at 5 min (0.85 ± 1.14) after EMR with prophylactic APC compared to 1 and 3 min (1 min: 0.28 ± 0.60, P < 0.001; 3 min: 0.65 ± 0.87, P = 0.02) and there was no significant difference between 5 and 7 min (P = 0.31). Multivariate analysis showed that the size of the iatrogenic ulcer after EMR was associated with the occurrence of visible vessels (ulcer size >1 vs. ≤0.5 cm: OR 27.32, 95% CI 2.86-infinity). CONCLUSIONS A 5-min observation of the ulcer may be advantageous for the assessment of visible vessels after performing colonic EMR with prophylactic APC, and large (>1 cm) iatrogenic ulcers were associated with the occurrence of visible vessels after colonic EMR.
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Kwon MJ, Kim YS, Bae SI, Park YI, Lee KJ, Min JH, Jo SY, Kim MY, Jung HJ, Jeong SY, Yoon WJ, Kim JN, Moon JS. Risk factors for delayed post-polypectomy bleeding. Intest Res 2015; 13:160-5. [PMID: 25932001 PMCID: PMC4414758 DOI: 10.5217/ir.2015.13.2.160] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/13/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023] Open
Abstract
Background/Aims Among the many complications that can occur following therapeutic endoscopy, bleeding is the most serious, which occurs in 1.0-6.1% of all colonoscopic polypectomies. The aim of this study was to identify risk factors of delayed post-polypectomy bleeding (PPB). Methods We retrospectively reviewed the data of patients who underwent colonoscopic polypectomy between January 2003 and December 2012. We compared patients who experienced delayed PPB with those who did not. The control-to-patient ratio was 3:1. The clinical data analyzed included polyp size, number, location, and shape, patient' body mass index (BMI), preventive hemostasis, and endoscopist experience. Results Of 1,745 patients undergoing colonoscopic polypectomy, 21 (1.2%) experienced significant delayed PPB. We selected 63 age- and sex-matched controls. Multivariate logistic regression analysis showed that polyps >10 mm (odds ratio [OR], 2.605; 95% confidence interval [CI], 1.035-4.528; P=0.049), a pedunculated polyp (OR, 3.517; 95% CI, 1.428-7.176; P=0.045), a polyp located in the right hemicolon (OR, 3.10; 95% CI, 1.291-5.761; P=0.013), and a high BMI (OR, 3.681; 95% CI, 1.876-8.613; P=0.013) were significantly associated with delayed PPB. Conclusions Although delayed PPB is a rare event, more caution is needed during colonoscopic polypectomies performed in patients with high BMI or large polyps, pedunculated polyps, or polyps located in the right hemicolon.
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Affiliation(s)
- Min Jung Kwon
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Song I Bae
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Young Il Park
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kyung Jin Lee
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Hwa Min
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Soo Yeon Jo
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Mi Young Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hye Jin Jung
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Seong Yeon Jeong
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Won Jae Yoon
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin Nam Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Xie HP, Hou W, Zhao Q. Risk factors for delayed postpolypectomy bleeding. Shijie Huaren Xiaohua Zazhi 2015; 23:486-490. [DOI: 10.11569/wcjd.v23.i3.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify risk factors for delayed postpolypectomy bleeding (DPPB) and analyze the correlations of these risk factors with DPPB.
METHODS: A total of 2292 polpyectomies performed in 1426 cases between November 2008 and April 2014 were retrospectively reviewed. Polyp-related and procedure-related factors were evaluated as potential risk factors for DPPB.
RESULTS: Delayed bleeding occurred in 20 (1.4%) cases. Multivariate analysis revealed that polyp size > 10 mm [odds ratio (OR) = 1.222, 95% confidence interval (CI): 1.205-1.239, (P = 0.003], location in the right hemicolon (OR = 1.152, 95%CI: 1.137-1.167, (P = 0.049), and inadequate endoscopic experience of endoscopist (OR = 1.307, 95%CI: 1.288-1.326, (P = 0.046) were significant risk factors for DPPB. Right-sided polypectomy by an inexperienced endoscopist (OR = 1.992, 95%CI: 1.975-2.009, (P = 0.000) significantly increased the risk for DPPB.
CONCLUSION: Polyp size, right hemicolon location andinadequate endoscopic experience of endoscopist were identified as potential risk factors for DPPB.
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Kim JH, Lee HJ, Ahn JW, Cheung DY, Kim JI, Park SH, Kim JK. Risk factors for delayed post-polypectomy hemorrhage: a case-control study. J Gastroenterol Hepatol 2013; 28:645-9. [PMID: 23369027 DOI: 10.1111/jgh.12132] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Delayed post-polypectomy hemorrhage is a rare but serious complication. The aim of this study was to identify risk factors for the development of delayed post-polypectomy hemorrhage. METHODS This was a retrospective case-control study of patients who developed delayed hematochezia after receiving colonoscopic polypectomy. The control patients underwent uneventful polypectomy and were selected at a 4:1 ratio. RESULTS Of the 7447 lesions examined from the 3253 patients who received colonoscopic polypectomy, 53 lesions (0.7%) of 42 patients (1.3%) developed delayed hemorrhage, and 168 patients were selected as controls. According to multivariate logistic regression analysis, a polyp larger than 10 mm (odds ratio [OR] 2.355, 95% confidence interval [CI] 1.225-4.528, P = 0.010), a pedunculated polyp (OR 3.473, 95% CI 1.576-7.657, P = 0.002), and a polyp located in the right hemi-colon (OR 2.690, 95% CI 1.465-4.940, P = 0.001) were significant risk factors for delayed post-polypectomy hemorrhage. The presence of comorbidities did not increase the risk of delayed hemorrhage. CONCLUSION Polyp size (large), shape (pedunculated), and location (right hemi-colon) represented substantial risk factors for the development of delayed hemorrhage after colonoscopic polypectomy.
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Affiliation(s)
- Jeong Ho Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Carter D, Beer-Gabel M, Zbar A, Avidan B, Bardan E. A survey of colonoscopic polypectomy practice amongst Israeli gastroenterologists. Ann Gastroenterol 2013; 26:135-140. [PMID: 24714780 PMCID: PMC3959924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 12/23/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Polypectomy techniques have been implicated as factors in the effectiveness of polyp resection. The range of polypectomy practices among gastroenterologists in Israel is unknown. METHODS A structured survey was sent to all Israeli gastroenterology departments in all 15 major academic hospitals and to 3 central outpatient clinics. RESULTS The survey was completed by 100 clinicians (45% contacted) derived from 13 of 15 academic centers (85%) and from all 3 outpatient clinics. Significant differences were noted in the preferred polypectomy for the resection of polyps 1-3 mm and 7-9 mm in diameter whereas for those polyps 4-6 mm in diameter, both the hot forceps and hot snare were most commonly used technique. Coagulation was employed in 42% of cases, pure cutting in 20% and blend current in 38% of cases. Narrow band imaging was used by 54% of practitioners, and only 33% of gastroenterologists regularly used dye spraying techniques. When removing pedunculated polyps >1 cm in diameter, 75% did not use any specific measures designed to prevent perforation or hemorrhage. Performance of >300 colonoscopies per year was associated with a greater use of dye spraying techniques and working in a hospital was more likely to be accompanied by clip deployment to larger polypectomy stalks as part of the procedure. CONCLUSION Our results demonstrate considerable heterogeneity in the techniques used for removal of polyps <1 cm. Most practitioners do not regularly use advanced techniques for polyp detection or for the prevention of post-polypectomy bleeding.
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Affiliation(s)
- Dan Carter
- Departments of Gastroenterology (Dan Carter, Marc Beer-Gabel, Benjamin Avidan, Eytan Bardan),
Correspondence to: Dan Carter, Gastroenterology Department, Sheba Medical Center, Ramat Gan, Israel and Tel Aviv University, Tel Aviv, Israel, Tel.: +972 3 530 2197, Fax: +972 3 530 3160, e-mail:
| | - Marc Beer-Gabel
- Departments of Gastroenterology (Dan Carter, Marc Beer-Gabel, Benjamin Avidan, Eytan Bardan)
| | - Andrew Zbar
- Surgery (Andrew Zbar), Sheba Medical Center, Ramat Gan, Israel and Tel Aviv University, Tel Aviv, Israel
| | - Benjamin Avidan
- Departments of Gastroenterology (Dan Carter, Marc Beer-Gabel, Benjamin Avidan, Eytan Bardan)
| | - Eytan Bardan
- Departments of Gastroenterology (Dan Carter, Marc Beer-Gabel, Benjamin Avidan, Eytan Bardan)
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Wu L, Han T, Fan X, Pan W, Wang C, Zhong H, Ai X, Zhang W, Xu X, Ye Z, Terai T, Sato N, Watanabe S, Das UN. Serum C-reactive protein as a possible marker to predict delayed hemorrhage after colonoscopic polypectomy. Med Sci Monit 2012; 18:CR480-485. [PMID: 22847196 PMCID: PMC3560690 DOI: 10.12659/msm.883267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Post-polypectomy hemorrhage is one of the complications of colonscopic polypectomy. And there is no definitive and convenient laboratory test that could be used to predict risk of delayed post-polypectomy hemorrhage. This research aimed to study risk prediction of delayed post-polypectomy hemorrhage using serum C-reactive protein (CRP) level as a marker. MATERIAL/METHODS In a retrospective, case-controlled study, 302 cases of post-polypectomy patients were divided into hemorrhage group and non-hemorrhage group. The CRP levels 24-hours after colonscopic treatment were compared between the two groups to assess whether elevated serum CRP levels in addition to other risk factors such as age, gender, smoking, alcohol consumption, hypertension (AHT) and size of polyps may predict risk of delayed post-polypectomy hemorrhage. RESULTS The hemorrhage group had significantly higher levels of serum CRP (32.50±17.34 mg/L vs. 6. 32±6.02 mg/dL) and were also having a higher incidence of hypertension compared to the non- hemorrhage group (both P<0.05). Patients with elevated serum CRP levels (≥10 mg/L) after colonscopic treatment are at a higher risk of developing post-polypectomy hemorrhage (OR 1.329, 95%CI 1.125-1.571) as compared with patients whose CRP levels were not increased. CONCLUSIONS A higher level of serum CRP may serve as an indicator of delayed post-polypectomy hemorrhage and there appears to be a direct relationship between the serum CRP levels and the risk of post-polypectomy hemorrhage: the higher CRP levels the higher the risk of post-polypectomy hemorrhage.
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Affiliation(s)
- Liangqin Wu
- Department of Gastroenterology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Bae GH, Jung JT, Kwon JG, Kim EY, Park JH, Seo JH, Kim JY. [Risk factors of delayed bleeding after colonoscopic polypectomy: case-control study]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:423-7. [PMID: 22735875 DOI: 10.4166/kjg.2012.59.6.423] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIMS Colonoscopic polypectomy is a valuable procedure for preventing colorectal cancer, but is not without complications. Delayed bleeding after colonoscopic polypectomy is a rare, but serious complication. The aim of this study was to identify risk factors of delayed bleeding after colonoscopic polypectomy. METHODS A retrospective case-control study was conducted in a single university hospital. Forty cases and 120 controls were included. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, endoscopist's experience, resection method, use of sedation, and use of prophylactic hemostasis. RESULTS In univariate analysis, size, histology and number of resected polyps, endoscopist's experience, resection method and use of prophylactic hemostasis were significant risk factors for delayed bleeding after colonoscopic polypectomy. In multivariate analysis, risk of delayed bleeding increased by 11.6% for every 1 mm increase in resected polyp diameter (OR, 1.116; 95% CI 1.041-1.198; p=0.002). Number of resected polyps (OR, 1.364; 95% CI, 1.113-1.671; p=0.003) and endoscopist's experience (OR, 6.301; 95% CI, 2.022-19.637; p=0.002) were significant risk factors for delayed bleeding after colonoscopic polypectomy. CONCLUSIONS Size and numbers of resected polyps, and endoscopist's experience were independent risk factors for delayed bleeding after colonoscopic polypectomy. More caution would be necessary when removing polyps with these factors.
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Affiliation(s)
- Gyu Hwan Bae
- Division of Gastroenterology, Department of Internal Medicine, Catholic University, Daegu College of Medicine, 33, Dooryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea
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Friedland S, Kothari S, Chen A, Park W, Banerjee S. Endoscopic mucosal resection with an over-the-counter hyaluronate preparation. Gastrointest Endosc 2012; 75:1040-4. [PMID: 22381528 DOI: 10.1016/j.gie.2012.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 01/05/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hyaluronic acid (HA) provides a long-lasting and distinct mucosal elevation for EMR, but expense and inconvenience have limited its adoption. OBJECTIVE To evaluate the safety and efficacy of an over-the-counter 0.15% HA preparation for EMR. DESIGN Retrospective study. SETTING Veterans Administration Hospital and university hospital. PATIENTS 30 patients with a total of 32 colonic lesions and 1 duodenal lesion. INTERVENTION EMR by using HA. MAIN OUTCOME MEASUREMENTS En bloc resection rate and complications. RESULTS EMR was successful in all cases. En bloc resection was achieved in 26 of the 28 lesions up to 25 mm in diameter. Two lesions, both with fibrosis from prior attempted resection, had trace residual tissue necessitating cauterization with argon plasma. Five lesions measuring 30 mm to 60 mm all required piecemeal resection. There was one complication, a postpolypectomy bleed. LIMITATIONS Small number of patients and retrospective design. CONCLUSIONS EMR may be performed safely and effectively by using an inexpensive, over-the-counter 0.15% HA preparation. Further studies are needed to verify the results of this study and to compare the safety and efficacy of this HA preparation with saline solution.
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Affiliation(s)
- Shai Friedland
- Department of Gastroenterology, Veterans Administration Palo Alto Health Care System, Palo Alto, California, USA.
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