Risk factors for delayed bleeding after intestinal polypectomy in children
WANG Yue-Sheng, ZHANG Jing, XUE Fu-Min, YU Jing, LI Xiao-Qin
Department of Gastroenterology, Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhenzhou 450018, China (Li X-Q, Email: lixiaoqinys@126.com)
Abstract Objective To investigate the clinical characteristics and risk factors of delayed bleeding after intestinal polypectomy in children, and to provide a theoretical basis for clinical surgical intervention of intestinal polyps. Methods A retrospective analysis was conducted on the clinical data of 2 456 children with intestinal polyps who underwent endoscopic high-frequency electrocoagulation loop resection in the Endoscopy Center of Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. According to the presence or absence of delayed bleeding after surgery, they were divided into bleeding group with 79 children and non-bleeding group with 2 377 children. A multivariate logistic regression analysis was used to investigate the risk factors for delayed bleeding. The receiver operating characteristic (ROC) curve was used to investigate the value of various indicators in predicting delayed bleeding. Results Of all 2 456 children, 79 (3.22%) experienced delayed bleeding, among whom 5 children with severe delayed bleeding underwent emergency colonoscopy for hemostasis and 74 received conservative treatment, and successful hemostasis was achieved for all children. There were significant differences between the bleeding and non-bleeding groups in age, body mass index, constipation rate, location of lesion, time of endoscopic procedure, resection method (P<0.05). Children with a diameter of polyps of 6-10 mm and >20 mm were more likely to develop delayed bleeding after resection (P<0.05). The multivariate logistic regression analysis showed that endoscopic operation time, polyp diameter, and resection method were significantly associated with delayed bleeding (P<0.05). The ROC curve analysis showed that the endoscopic operation time, polyp diameter, and resection method had a good value in predicting delayed bleeding after intestinal polypectomy, with an area under the ROC curve of 0.706, 0.688, and 0.627, respectively. Conclusions Endoscopic high-frequency electrocoagulation loop resection has a lower incidence of delayed bleeding in children with intestinal polyps, and the endoscopic operation time, polyp diameter, and resection method are closely associated with the occurrence of postoperative delayed bleeding.
Tsuruta S, Tominaga N, Ogata S, et al. Risk factors for delayed hemorrhage after colonic endoscopic mucosal resection in patients not on antithrombotic therapy: retrospective analysis of 3,844 polyps of 1,660 patients[J]. Digestion, 2019, 100(2): 86-92. PMID: 30448830. DOI: 10.1159/000494455.
Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline[J]. Endoscopy, 2017, 49(3): 270-297. PMID: 28212588. DOI: 10.1055/s-0043-102569.
Hassan C, Repici A, Sharma P, et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis[J]. Gut, 2016, 65(5): 806-820. PMID: 25681402. DOI: 10.1136/gutjnl-2014-308481.
Choung BS, Kim SH, Ahn DS, et al. Incidence and risk factors of delayed postpolypectomy bleeding: a retrospective cohort study[J]. J Clin Gastroenterol, 2014, 48(9): 784-789. PMID: 24231934. DOI: 10.1097/MCG.0000000000000027.
Park SK, Seo JY, Lee MG, et al. Prospective analysis of delayed colorectal post-polypectomy bleeding[J]. Surg Endosc, 2018, 32(7): 3282-3289. PMID: 29344790. DOI: 10.1007/s00464-018-6048-9.
Ye B, Wu Y, Tang X. Risk factors of post-polypectomy bleeding and recurrence in children with colorectal polyps after endoscopic mucosal resection: a retrospective cohort study[J]. Transl Pediatr, 2022, 11(11): 1823-1830. PMID: 36506768. PMCID: PMC9732596. DOI: 10.21037/tp-22-518.
Spadaccini M, Albéniz E, Pohl H, et al. Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: meta-analysis of randomized trials[J]. Gastroenterology, 2020, 159(1): 148-158.e11. PMID: 32247023. DOI: 10.1053/j.gastro.2020.03.051.
Forbes N, Frehlich L, James MT, et al. Routine prophylactic endoscopic clipping is not efficacious in the prevention of delayed post-polypectomy bleeding: a systematic review and meta-analysis of randomized controlled trials[J]. J Can Assoc Gastroenterol, 2019, 2(3): 105-117. PMID: 31294373. PMCID: PMC6619410. DOI: 10.1093/jcag/gwy033.
Rodríguez de Santiago E, Hernández-Tejero M, Rivero-Sánchez L, et al. Management and outcomes of bleeding within 30 days of colonic polypectomy in a large, real-life, multicenter cohort study[J]. Clin Gastroenterol Hepatol, 2021, 19(4): 732-742.e6. PMID: 32272252. DOI: 10.1016/j.cgh.2020.03.068.
Li D, Wang W, Xie J, et al. Efficacy and safety of three different endoscopic methods in treatment of 6-20 mm colorectal polyps[J]. Scand J Gastroenterol, 2020, 55(3): 362-370. PMID: 32150478. DOI: 10.1080/00365521.2020.1732456.
Yang TC, Wu YH, Lee PC, et al. Prophylactic clipping after endoscopic mucosal resection of large nonpedunculated colorectal lesions: a meta-analysis[J]. J Gastroenterol Hepatol, 2021, 36(7): 1778-1787. PMID: 33638894. DOI: 10.1111/jgh.15472.
Branch of Pediatric Critical Care Physicians, Chinese Medical Association; Neonatologists Branch of Chinese Medical Association; Gansu Provincial Maternal and Child Health Hospital/Gansu Provincial Central Hospital/Gansu Pediatric Clinical Medical Research Center; Center for Evidence-Based Medicine, School of Basic Medicine, Lanzhou University/WHO Guidelines for Practice and Knowledge Transformation Cooperation Center/Gansu Province Medical Guideline Technology Center. Clinical practice guidelines for bronchoalveolar lavage in Chinese children (2024)[J]. CJCP, 2024, 26(1): 1-13.
