Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Gastrointest Endosc. 2024 Oct;100(4):718-727. doi: 10.1016/j.gie.2024.03.021. Epub 2024 Mar 20.
Delayed bleeding (DB) is a major adverse event associated with colorectal endoscopic submucosal dissection (ESD) that sometimes causes difficulties in making decisions regarding endoscopic hemostasis. This study identified the factors that contribute to follow-up without endoscopic hemostasis when DB is suspected after colorectal ESD.
In total, 583 patients (603 tumors) who underwent ESD or hybrid ESD for colorectal tumors at Chiba University Hospital between June 2009 and January 2022 were retrospectively registered. Of these, 141 cases (141 tumors) with DB, and hematochezia or hemoglobin decrease ≥2 g/dL after colorectal ESD, were analyzed. The DB group was divided into the Hemostasis group (H group; endoscopic hemostasis performed) and no-Hemostasis group (no-H group; no endoscopy performed, or endoscopy performed but no hemostasis performed after hematochezia or hemoglobin decrease). Univariate and multivariate logistic regression analyses were conducted to assess the factors contributing to follow-up.
Thirty-one patients with 31 tumors were categorized into the H group, and 110 patients with 110 tumors were in the no-H group. Multivariate regression analysis revealed that date from ESD to first hematochezia ≤Day 3 (odds ratio, 4.55; 95% confidence interval, 1.44-14.33; P = .010) and bleeding duration ≤1 day (odds ratio, 3.35; 95% confidence interval, 1.35-8.34; P = .009) contributed to follow-up.
In cases of DB after colorectal ESD, a bleeding duration ≤1 day or date from ESD to first hematochezia ≤Day 3 may contribute to follow-up observation without endoscopic hemostasis.
延迟性出血（DB）是与结直肠内镜黏膜下剥离术（ESD）相关的主要不良事件，有时会导致内镜止血决策困难。本研究旨在确定在结直肠 ESD 后怀疑 DB 时，无需内镜止血即可进行随访的相关因素。
回顾性登记了 2009 年 6 月至 2022 年 1 月期间在千叶大学医院接受结直肠肿瘤 ESD 或混合 ESD 的 583 例患者（603 个肿瘤）。其中，分析了 141 例（141 个肿瘤）DB 患者，这些患者在结直肠 ESD 后出现血便或血红蛋白下降≥2 g/dL。将 DB 组分为止血组（H 组；进行内镜止血）和非止血组（no-H 组；未进行内镜检查，或在血便或血红蛋白下降后进行内镜检查但未进行止血）。进行单因素和多因素逻辑回归分析，以评估与随访相关的因素。
31 例患者的 31 个肿瘤归入 H 组，110 例患者的 110 个肿瘤归入 no-H 组。多因素回归分析显示，ESD 至首次血便的时间≤3 天（比值比，4.55；95%置信区间，1.44-14.33；P=0.010）和出血时间≤1 天（比值比，3.35；95%置信区间，1.35-8.34；P=0.009）与随访相关。
在结直肠 ESD 后出现 DB 的情况下，出血时间≤1 天或 ESD 至首次血便的时间≤3 天可能有助于无需内镜止血的随访观察。
