Guo Xue-Feng, Yu Xiang-An, Hu Jian-Cong, Lin De-Zheng, Deng Jia-Xin, Su Ming-Li, Li Juan, Liu Wei, Zhang Jia-Wei, Zhong Qing-Hua
Department of Endoscopic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Gastroenterol Rep (Oxf). 2021 Nov 15;10:goab051. doi: 10.1093/gastro/goab051. eCollection 2022.
The resection of small colorectal polyps (≤10 mm) is routine for endoscopists. However, the management of one of its main complications, namely delayed (within 14 days) postpolypectomy bleeding (DPPB), has not been clearly demonstrated. We aimed to assess the role of coloscopy in the management of DPPB from small colorectal polyps and identify the associated factors for initial hemostatic success.
We conducted a retrospective study of 69 patients who developed DPPB after the removal of colorectal polyps of ≤10 mm and underwent hemostatic colonoscopy at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between April 2013 and June 2021. Demographics, clinical variables, and colonoscopic features were collected independently. We applied univariate and multivariate analyses to assess factors associated with initial hemostatic success.
General colonoscopy without oral bowel preparation was successfully performed in all the patients, with a median duration of 23.9 (12.5-37.9) minutes. Among 69 patients, 62 (89.9%) achieved hemostasis after initial hemostatic colonoscopy and 7 (10.1%) rebled 2.7 ± 1.1 days after initial colonoscopic hemostasis and had rebleeding successfully controlled by one additional colonoscopy. No colonoscopy-related adverse events occurred. Multivariate analysis showed that management with at least two clips was the only independent prognostic factor for initial hemostatic success (odds ratio, 0.17; 95% confidence interval, 0.03-0.91; = 0.04). All the patients who had at least two clips placed at the initial hemostatic colonoscopy required no further hemostatic intervention.
Colonoscopy is a safe, effective, and not too time-consuming approach for the management of patients with DPPB of small colorectal polyps and management with the placement of at least two hemoclips may be beneficial.
切除小的结直肠息肉（≤10毫米）是内镜医师的常规操作。然而，对于其主要并发症之一，即息肉切除术后延迟性（14天内）出血（DPPB）的处理，尚未得到明确证实。我们旨在评估结肠镜检查在处理小的结直肠息肉所致DPPB中的作用，并确定初次止血成功的相关因素。
我们对69例在2013年4月至2021年6月期间于中山大学附属第六医院（中国广州）切除≤10毫米结直肠息肉后发生DPPB并接受止血结肠镜检查的患者进行了一项回顾性研究。独立收集人口统计学、临床变量和结肠镜特征。我们应用单因素和多因素分析来评估与初次止血成功相关的因素。
所有患者均成功进行了未口服肠道准备的普通结肠镜检查，中位检查时间为23.9（12.5 - 37.9）分钟。69例患者中，62例（89.9%）在初次止血结肠镜检查后实现止血，7例（10.1%）在初次结肠镜止血后2.7±1.1天再次出血，并通过再次结肠镜检查成功控制了再出血。未发生与结肠镜检查相关的不良事件。多因素分析显示，使用至少两个夹子进行处理是初次止血成功的唯一独立预后因素（比值比，0.17；95%置信区间，0.03 - 0.91；P = 0.04）。所有在初次止血结肠镜检查时放置至少两个夹子的患者均无需进一步的止血干预。
结肠镜检查是处理小的结直肠息肉所致DPPB患者的一种安全、有效且不太耗时的方法，放置至少两个止血夹进行处理可能有益。
