Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, South Korea.
Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, South Korea.
Surg Endosc. 2018 Jul;32(7):3282-3289. doi: 10.1007/s00464-018-6048-9. Epub 2018 Jan 17.
BACKGROUNDS/AIMS: Although post-polypectomy bleeding is the most frequent complication after colonoscopic polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-polypectomy bleeding and its associated risk factors prospectively.
Patients who underwent colonoscopic polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30 days after polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as a > 2-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24 h after polypectomy.
A total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age (< 50 years; odds ratio [OR] 2.10; 95% confidence interval [CI] 1.18-3.68), aspirin use (OR 2.78; 95% CI 1.23-6.31), and polyp size of > 10 mm (OR 2.45; 95% CI 1.38-4.36) were significant risk factors for major delayed bleeding, while young age (< 50 years; OR 2.6; 95% CI 1.35-5.12) and immediate bleeding (OR 3.3; 95% CI 1.49-7.30) were significant risk factors for late delayed bleeding.
Young age, aspirin use, polyp size, and immediate bleeding were found to be independent risk factors for delayed post-polypectomy bleeding.
背景/目的：虽然息肉切除术后出血是结肠镜息肉切除术后最常见的并发症，但只有少数研究前瞻性地调查了出血的发生率。本研究旨在前瞻性调查延迟性息肉切除术后出血的发生率及其相关危险因素。
本研究前瞻性纳入 2013 年 1 月至 2014 年 12 月在康伯斯三星医院行结肠镜息肉切除术的患者。经过培训的护士在息肉切除术后 7 天和 30 天通过电话联系患者，并完成一份关于出血发生情况的标准化问卷。延迟性息肉切除术后出血分为轻微或严重出血，以及早期或晚期出血。严重延迟性出血定义为血红蛋白水平下降>2g/dL，需要住院控制出血或输血；晚期延迟性出血定义为息肉切除术后 24 小时后发生的出血。
共对 3887 例患者的 8175 例结肠镜息肉切除术进行了研究。共有 133 例（3.4%）患者发生延迟性息肉切除术后出血。其中，90 例（2.3%）和 43 例（1.1%）患者发生轻微和严重延迟性出血，39 例（1.0%）患者发生晚期延迟性出血。基于息肉的多变量分析，年龄较轻（<50 岁；比值比 [OR] 2.10；95%置信区间 [CI] 1.18-3.68）、使用阿司匹林（OR 2.78；95% CI 1.23-6.31）和息肉大小>10mm（OR 2.45；95% CI 1.38-4.36）是严重延迟性出血的显著危险因素，而年龄较轻（<50 岁；OR 2.6；95% CI 1.35-5.12）和即刻出血（OR 3.3；95% CI 1.49-7.30）是晚期延迟性出血的显著危险因素。
年龄较轻、使用阿司匹林、息肉大小和即刻出血被发现是延迟性息肉切除术后出血的独立危险因素。
