A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions

Albeniz, E; Fraile, M; Ibanez, B; Alonso-Aguirre, P; Martinez-Ares, D; Soto, S; Gargallo, CJ; Zabala, FR; Alvarez, MA; Rodriguez-Sanchez, J; Mugica, F; Nogales, O; de Tejada, AH; Redondo, E; Guarner-Argente, C; Pin, N; Leon-Brito, H; Pardeiro, R; Lopez-Roses, L; Rodriguez-Tellez, M; Jimenez, A; Martinez-Alcala, F; Garcia, O; de la Pena, J; Ono, A; de las Parras, F; Pellise, M; Rivero, L; Saperas, E; Perez-Roldan, F; Royo, AP; Ros, JE; Ripa, AZ; Concepcion-Martin, M; Huelin-Alvarez, P; Colan-Hernandez, J; Cubiella, J; Remedios, D; Caserras, XBI; Lopez-Viedma, B; Cobian, J; Gonzalez-Haba, M; Santiago, J; Martinez-Cara, JG; Valdivielso, E

A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions

BACKGROUND & AIMS: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after di...

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Autores:	Albeniz, E, Fraile, M, Ibanez, B, Alonso-Aguirre, P, Martinez-Ares, D, Soto, S, Gargallo, CJ, Zabala, FR, Alvarez, MA, Rodriguez-Sanchez, J, Mugica, F, Nogales, O, de Tejada, AH, Redondo, E, Guarner-Argente, C, Pin, N, Leon-Brito, H, Pardeiro, R, Lopez-Roses, L, Rodriguez-Tellez, M, Jimenez, A, Martinez-Alcala, F, Garcia, O, de la Pena, J, Ono, A, de las Parras, F, Pellise, M, Rivero, L, Saperas, E, Perez-Roldan, F, Royo, AP, Ros, JE, Ripa, AZ, Concepcion-Martin, M, Huelin-Alvarez, P, Colan-Hernandez, J, Cubiella, J, Remedios, D, Caserras, XBI, Lopez-Viedma, B, Cobian, J, Gonzalez-Haba, M, Santiago, J, Martinez-Cara, JG, Valdivielso, E
Tipo de recurso:	artículo
Estado:	Versión publicada
Fecha de publicación:	2016
País:	España
Institución:	Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:	r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:	oai:iibsantpau.fundanetsuite.com:p7110
Acceso en línea:	https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=7110
Access Level:	acceso abierto
Palabra clave:	ASA Mucosectomy Colon Cancer Prognostic Factor

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spelling	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal LesionsAlbeniz, EFraile, MIbanez, BAlonso-Aguirre, PMartinez-Ares, DSoto, SGargallo, CJZabala, FRAlvarez, MARodriguez-Sanchez, JMugica, FNogales, Ode Tejada, AHRedondo, EGuarner-Argente, CPin, NLeon-Brito, HPardeiro, RLopez-Roses, LRodriguez-Tellez, MJimenez, AMartinez-Alcala, FGarcia, Ode la Pena, JOno, Ade las Parras, FPellise, MRivero, LSaperas, EPerez-Roldan, FRoyo, APRos, JERipa, AZConcepcion-Martin, MHuelin-Alvarez, PColan-Hernandez, JCubiella, JRemedios, DCaserras, XBILopez-Viedma, BCobian, JGonzalez-Haba, MSantiago, JMartinez-Cara, JGValdivielso, EASAMucosectomyColon CancerPrognostic FactorBACKGROUND & AIMS: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk. METHODS: We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the beta parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding. RESULTS: Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age >= 75 years (odds ratio [OR], 2.36; P<.01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P <= .05), aspirin use during EMR (OR, 3.16; P<.05), right-sided lesions (OR, 4.86; P<.01), lesion size >= 40 mm (OR, 1.91; P <= .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P <= .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively. CONCLUSIONS: The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.ELSEVIER SCIENCE INC2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=7110Clinical Gastroenterology and HepatologyISSN: 15423565ISSNe: 15427714reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p71102026-06-14T12:41:47Z
dc.title.none.fl_str_mv	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
title	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
spellingShingle	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions Albeniz, E ASA Mucosectomy Colon Cancer Prognostic Factor
title_short	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
title_full	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
title_fullStr	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
title_full_unstemmed	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
title_sort	A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
dc.creator.none.fl_str_mv	Albeniz, E Fraile, M Ibanez, B Alonso-Aguirre, P Martinez-Ares, D Soto, S Gargallo, CJ Zabala, FR Alvarez, MA Rodriguez-Sanchez, J Mugica, F Nogales, O de Tejada, AH Redondo, E Guarner-Argente, C Pin, N Leon-Brito, H Pardeiro, R Lopez-Roses, L Rodriguez-Tellez, M Jimenez, A Martinez-Alcala, F Garcia, O de la Pena, J Ono, A de las Parras, F Pellise, M Rivero, L Saperas, E Perez-Roldan, F Royo, AP Ros, JE Ripa, AZ Concepcion-Martin, M Huelin-Alvarez, P Colan-Hernandez, J Cubiella, J Remedios, D Caserras, XBI Lopez-Viedma, B Cobian, J Gonzalez-Haba, M Santiago, J Martinez-Cara, JG Valdivielso, E
author	Albeniz, E
author_facet	Albeniz, E Fraile, M Ibanez, B Alonso-Aguirre, P Martinez-Ares, D Soto, S Gargallo, CJ Zabala, FR Alvarez, MA Rodriguez-Sanchez, J Mugica, F Nogales, O de Tejada, AH Redondo, E Guarner-Argente, C Pin, N Leon-Brito, H Pardeiro, R Lopez-Roses, L Rodriguez-Tellez, M Jimenez, A Martinez-Alcala, F Garcia, O de la Pena, J Ono, A de las Parras, F Pellise, M Rivero, L Saperas, E Perez-Roldan, F Royo, AP Ros, JE Ripa, AZ Concepcion-Martin, M Huelin-Alvarez, P Colan-Hernandez, J Cubiella, J Remedios, D Caserras, XBI Lopez-Viedma, B Cobian, J Gonzalez-Haba, M Santiago, J Martinez-Cara, JG Valdivielso, E
author_role	author
author2	Fraile, M Ibanez, B Alonso-Aguirre, P Martinez-Ares, D Soto, S Gargallo, CJ Zabala, FR Alvarez, MA Rodriguez-Sanchez, J Mugica, F Nogales, O de Tejada, AH Redondo, E Guarner-Argente, C Pin, N Leon-Brito, H Pardeiro, R Lopez-Roses, L Rodriguez-Tellez, M Jimenez, A Martinez-Alcala, F Garcia, O de la Pena, J Ono, A de las Parras, F Pellise, M Rivero, L Saperas, E Perez-Roldan, F Royo, AP Ros, JE Ripa, AZ Concepcion-Martin, M Huelin-Alvarez, P Colan-Hernandez, J Cubiella, J Remedios, D Caserras, XBI Lopez-Viedma, B Cobian, J Gonzalez-Haba, M Santiago, J Martinez-Cara, JG Valdivielso, E
author2_role	author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author
dc.subject.none.fl_str_mv	ASA Mucosectomy Colon Cancer Prognostic Factor
topic	ASA Mucosectomy Colon Cancer Prognostic Factor
description	BACKGROUND & AIMS: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk. METHODS: We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the beta parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding. RESULTS: Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age >= 75 years (odds ratio [OR], 2.36; P<.01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P <= .05), aspirin use during EMR (OR, 3.16; P<.05), right-sided lesions (OR, 4.86; P<.01), lesion size >= 40 mm (OR, 1.91; P <= .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P <= .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively. CONCLUSIONS: The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.
publishDate	2016
dc.date.none.fl_str_mv	2016
dc.type.none.fl_str_mv	info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion
format	article
status_str	publishedVersion
dc.identifier.none.fl_str_mv	https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=7110
url	https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=7110
dc.language.none.fl_str_mv	Inglés
language_invalid_str_mv	Inglés
dc.rights.none.fl_str_mv	info:eu-repo/semantics/openAccess
eu_rights_str_mv	openAccess
dc.publisher.none.fl_str_mv	ELSEVIER SCIENCE INC
publisher.none.fl_str_mv	ELSEVIER SCIENCE INC
dc.source.none.fl_str_mv	Clinical Gastroenterology and Hepatology ISSN: 15423565 ISSNe: 15427714 reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str	Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str	r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection	r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score	15.812455

A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions

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