Maeda Takato, Sakuraba Hirotake, Oyama Takao, Nakagawa Satoru, Ota Shinji, Murai Yasuhisa, Machida Ryuma, Ishidoya Nao, Kikuchi Hidezumi, Chinda Daisuke, Sakamoto Juichi, Iwamura Hideki
Department of Gastroenterology, Tsugaru General Hospital, Aomori, Japan.
Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan.
J Anus Rectum Colon. 2024 Jul 30;8(3):204-211. doi: 10.23922/jarc.2023-076. eCollection 2024.
Delayed bleeding is the most frequent adverse event associated with endoscopic mucosal resection (EMR) and hot snare polypectomy (HSP) of colorectal polyps. However, whether the incidence of delayed bleeding differs between outpatient and inpatient treatment is unknown. Therefore, in this study, we aimed to evaluate delayed bleeding rates between outpatient and inpatient endoscopic treatments and clarify the safety of outpatient treatment.
We enrolled 469 patients (1077 polyps) and 420 patients (1080 polyps) in the outpatient and inpatient groups, respectively, who underwent EMR or HSP for colorectal polyps at our institution between April 2020 and May 2023. Using propensity score matching, we evaluated the delayed bleeding rates between the two groups. Delayed bleeding was defined as a hemorrhage requiring endoscopic hemostasis occurring within 14 days of the procedure.
Propensity score matching created 376 (954 polyps) matched patient pairs. The median maximum diameter of polyps removed was 10 mm in both groups. Delayed bleeding rates per patients were 1.3% (5/376) in the outpatient group and 2.9% (11/376) in the inpatient group (P=0.21). In term of per polyp, early delayed bleeding (occurring within 24 hours) rates were higher in the inpatient group than outpatient group (0.2% [2/954] vs. 1.1% [10/954], respectively; P=0.04). No severe bleeding requiring a transfusion occurred in either group.
Outpatient endoscopic treatment did not increase delayed bleeding compared with inpatient treatment. Outpatient treatment would be safe and common for the removal of colorectal polyps.
延迟性出血是与大肠息肉内镜黏膜切除术（EMR）和热圈套息肉切除术（HSP）相关的最常见不良事件。然而，门诊治疗和住院治疗的延迟性出血发生率是否存在差异尚不清楚。因此，在本研究中，我们旨在评估门诊和住院内镜治疗的延迟性出血率，并阐明门诊治疗的安全性。
我们分别纳入了门诊组469例患者（1077枚息肉）和住院组420例患者（1080枚息肉），这些患者于2020年4月至2023年5月在我院接受了大肠息肉的EMR或HSP治疗。使用倾向评分匹配法，我们评估了两组之间的延迟性出血率。延迟性出血定义为在手术后14天内发生的需要内镜止血的出血。
倾向评分匹配产生了376对（954枚息肉）匹配的患者对。两组切除息肉的最大直径中位数均为10 mm。门诊组患者的延迟性出血率为1.3%（5/376），住院组为2.9%（11/376）（P=0.21）。就每枚息肉而言，住院组早期延迟性出血（24小时内发生）率高于门诊组（分别为0.2%[2/954]和1.1%[10/954]；P=0.04）。两组均未发生需要输血的严重出血。
与住院治疗相比，门诊内镜治疗并未增加延迟性出血。门诊治疗对于大肠息肉切除是安全且常见的。
