Department of Gastroenterology and Hepatology, University of Sydney at Westmead Hospital, Sydney, NSW, Australia.
Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, SA, Australia.
Clin Gastroenterol Hepatol. 2014 Apr;12(4):651-61.e1-3. doi: 10.1016/j.cgh.2013.09.049. Epub 2013 Oct 1.
BACKGROUND & AIMS: Wide-field endoscopic mucosal resection (WF-EMR) of large sessile colonic polyps is a safe and cost-effective outpatient treatment. Bleeding is the main complication. Few studies have examined risk factors for bleeding during the procedure (intraprocedural bleeding [IPB]) or after it (clinically significant post-endoscopic bleeding [CSPEB]). We investigated factors associated with IPB and CSPEB in a large prospective study.
We analyzed data from WF-EMRs of sessile colorectal polyps ≥ 20 mm in size (mean size, 35.5 mm), which were performed on 1172 patients (mean age, 67.8 years) from June 2008-March 2013 at 7 tertiary hospitals as part of the Australian Colonic Endoscopic Resection Study. Data were collected on characteristics of patients and lesions, along with outcomes of procedures and clinical and histologic analyses. Independent predictors of IPB and CSPEB were identified by multiple logistic regression analysis.
Of the patients studied, 133 (11.3%) had IPB. Independent predictors included increasing lesion size (odds ratio, 1.24/10 mm; P < .001), Paris endoscopic classification of 0-IIa + Is (odds ratio, 2.12; P = .004), tubulovillous or villous histology (odds ratio, 1.84; P = .007), and study institutions that performed the procedure on fewer than 75 patients (odds ratio, 3.78; P < .001). All IPB was successfully controlled endoscopically. IPB prolonged procedures and was associated with early recurrence (relative risk, 1.68; P = .011). Seventy-three patients (6.2%) had CSPEB. On multivariable analysis, CSPEB was associated with proximal colon location (odds ratio, 3.72; P < .001), use of an electrosurgical current not controlled by a microprocessor (odds ratio, 2.03; P = .038), and IPB (odds ratio, 2.16; P = .016). Lesion size and comorbidities did not predict CSPEB.
In a prospective study of patients undergoing WF-EMR of large sessile colonic polyps, IPB is associated with larger lesions, lesion histology, and Paris endoscopic classification of type 0-IIa + Is. IPB prolongs the duration of the procedure, is a marker for recurrence, and is associated with CSPEB. CSPEB occurs most frequently in the proximal colon and less when current is controlled by a microprocessor.
宽场内镜黏膜切除术（WF-EMR）是一种安全且具有成本效益的门诊治疗方法，适用于大型无蒂结肠息肉。出血是主要的并发症。很少有研究探讨术中出血（IPB）或术后出血（CSPEB）的相关风险因素。我们通过一项大型前瞻性研究，调查了与 IPB 和 CSPEB 相关的因素。
我们分析了 2008 年 6 月至 2013 年 3 月在 7 家三级医院进行的大型 WF-EMR 治疗的大小≥20mm 无蒂结直肠息肉患者的数据（平均大小 35.5mm），共纳入 1172 例患者（平均年龄 67.8 岁）。数据收集了患者和病变的特征，以及操作结果和临床及组织学分析。采用多因素逻辑回归分析确定 IPB 和 CSPEB 的独立预测因素。
在研究的患者中，有 133 例（11.3%）发生 IPB。独立预测因素包括病变大小增加（每增加 10mm 的比值比，1.24；P＜0.001）、巴黎内镜分类 0-IIa+Is（比值比，2.12；P=0.004）、管状绒毛状或绒毛状组织学（比值比，1.84；P=0.007），以及操作例数少于 75 例的研究机构（比值比，3.78；P＜0.001）。所有 IPB 均经内镜成功控制。IPB 延长了手术时间，与早期复发相关（相对风险，1.68；P=0.011）。73 例（6.2%）发生 CSPEB。多因素分析显示，CSPEB 与结肠近端位置（比值比，3.72；P＜0.001）、未使用微处理器控制的电外科电流（比值比，2.03；P=0.038）以及 IPB（比值比，2.16；P=0.016）相关。病变大小和并存疾病与 CSPEB 无关。
在一项对接受 WF-EMR 治疗大型无蒂结肠息肉患者的前瞻性研究中，IPB 与较大的病变、病变组织学和巴黎内镜分类 0-IIa+Is 相关。IPB 延长了手术时间，是复发的标志，并与 CSPEB 相关。CSPEB 最常发生在结肠近端，当电流由微处理器控制时发生较少。
