Jaruvongvanich Veeravich, Prasitlumkum Narut, Assavapongpaiboon Buravej, Suchartlikitwong Sakolwan, Sanguankeo Anawin, Upala Sikarin
Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA.
Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Int J Colorectal Dis. 2017 Oct;32(10):1399-1406. doi: 10.1007/s00384-017-2870-0. Epub 2017 Aug 5.
Delayed post-polypectomy bleeding (PPB) is an infrequent but serious adverse event after colonoscopic polypectomy. Several studies have tried to identify risk factors for delayed PPB, with inconsistent results. This meta-analysis aims to identify significant risk factors for delayed PPB.
MEDLINE and EMBASE databases were searched through January 2016 for studies that investigated the risk factors for delayed PPB. Pooled odds ratio (OR) for categorical variables and mean differences (MD) for continuous variables and 95% confidence interval (CI) were calculated using a random-effect model, generic inverse variance method. The between-study heterogeneity of effect size was quantified using the Q statistic and I .
Twelve articles involving 14,313 patients were included. The pooled delayed PPB rate was 1.5% (95%CI, 0.7-3.4%), I = 96%. Cardiovascular disease (OR = 1.55), hypertension (OR = 1.53), polyp size > 10 mm (OR = 3.41), and polyps located in the right colon (OR = 1.60) were identified as significant risk factors for delayed PPB, whereas age, sex, alcohol use, smoking, diabetes, cerebrovascular disease, pedunculated morphology, and carcinoma histology were not.
Cardiovascular disease, hypertension, polyp size, and polyp location were associated with delayed PPB. More caution is needed when removing polyps in patients with these risk factors. Future studies are warranted to determine appropriate preventive hemostatic measures in these patients.
息肉切除术后延迟出血（PPB）是结肠镜息肉切除术后一种罕见但严重的不良事件。多项研究试图确定延迟PPB的危险因素，但结果不一致。本荟萃分析旨在确定延迟PPB的显著危险因素。
检索MEDLINE和EMBASE数据库至2016年1月，查找调查延迟PPB危险因素的研究。使用随机效应模型、通用逆方差法计算分类变量的合并比值比（OR）和连续变量的平均差（MD）以及95%置信区间（CI）。使用Q统计量和I2对效应大小的研究间异质性进行量化。
纳入12篇文章，涉及14313例患者。延迟PPB的合并发生率为1.5%（95%CI，0.7 - 3.4%），I2 = 96%。心血管疾病（OR = 1.55）、高血压（OR = 1.53）、息肉大小>10 mm（OR = 3.41）以及位于右半结肠的息肉（OR = 1.60）被确定为延迟PPB的显著危险因素，而年龄、性别、饮酒、吸烟、糖尿病、脑血管疾病、带蒂形态和癌组织学则不是。
心血管疾病、高血压、息肉大小和息肉位置与延迟PPB相关。对有这些危险因素的患者进行息肉切除时需要更加谨慎。有必要开展进一步研究以确定这些患者合适的预防性止血措施。
