Okugawa Takuya, Oshima Tadayuki, Nakai Keisuke, Eda Hirotsugu, Tamura Akio, Hara Ken, Ogawa Tomohiro, Kono Tomoaki, Kondo Takashi, Tozawa Katsuyuki, Fukushima Masashi, Tomita Toshihiko, Fukui Hirokazu, Watari Jiro, Miwa Hiroto
Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya 663-8501, Japan.
J Clin Med. 2021 Mar 1;10(5):928. doi: 10.3390/jcm10050928.
The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6-2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection.
This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared.
A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction.
The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.
据报道，结直肠息肉切除术后延迟出血的发生率为0.6%-2.8%。随着在持续使用抗血栓药物的情况下息肉切除术的开展越来越多，需要关注息肉切除术后延迟出血（DPPB）。因此，需要对内镜医师进行更好的指导。我们旨在评估指导的效果以及与内镜下结直肠息肉切除术后延迟出血相关的因素。
本单中心回顾性研究旨在评估检查完全止血的指导以及DPPB发生的危险因素。从病历中评估延迟出血的发生率、合并症和用药情况。比较历史对照患者和接受指导后患者的特征。
共评估了1002例患者的3318个息肉。对照组包括458例患者的1479个息肉，接受指导后组包括544例患者的1839个息肉。对照组息肉中DPPB的发生率为1.1%，接受指导后组为0.4%。指导显著降低了延迟出血，尤其是在使用抗血栓药物的情况下。即使在接受指导后，热活检钳息肉切除术、夹子放置和使用抗血栓药物仍是DPPB的显著独立危险因素。
在接受检查完全止血的指导后，延迟出血率显著降低。即使在接受指导后，使用抗血栓药物或热活检钳息肉切除术的情况下仍可能发生延迟出血。
