| Background and Object: Endoscopic colorectal polypectomy can reduce the incidence of colorectal cancer,but it may also have complications such as bleeding,perforation and postoperative syndrome.Bleeding after polypectomy is one of the most common complications,especially delayed bleeding.Early identification of risk factors for delayed bleeding after polypectomy is particularly important to reduce the incidence of bleeding.Therefore,this study mainly analyzes the related risk factors of delayed bleeding in order to better prevent the occurrence of delayed bleeding after operation,and to evaluate the efficacy of prophylactic use of hemostatic clip and the incidence of delayed bleeding after polypectomy.Methods:1.We reviewed 1516 patients who underwent colonoscopic resection of ≥0.5cm polyps in The Second Affiliated Hospital of Dalian Medical University from October2018 to October 2019.The general data of the patients was collected,including sex,age,drinking history,hypertension,hyperlipidemia,diabetes.Collect polyp related data,including polyp location,size,pedicle,pathological type and the use of hemoclips after polypectomy.2.The patients included in this study were divided into bleeding group and non-bleeding group according to the bleeding after polypectomy.Multivariate analysis was used to determine the risk factors of delayed bleeding.According to the situation of using hemoclips to prevent hemostasis after polypectomy,the patients were divided into hemoclip group and non-hemoclip group.The delayed bleeding rate of the two groups was compared and the effect of prophylactic application of hemoclips was evaluated.Results:1.A total of 1516 patients were included in this study,including 867 male patients(57.2%)and 649 female patients(42.8%).The average age was 59.53±11.288 years old.There were 529 patients with hypertension,245 patients with diabetes and 572 patients with hyperlipidemia.A total of 3240 polyps were removed,including 2152 polyps in 0.5-0.9cm,935 polyps in 1.0-1.9cm and 153 polyps ≥2.0cm,927 polyps in cecum and ascending colon,704 polyps in transverse colon,204 polyps in descending colon,834 polyps in sigmoid colon and 571 polyps in rectum.There were 1196 pedicled polyps and 2044 sessile polyps,2394 adenomatous polyps and846 non-adenomatous polyps,1810 polyps with metal clips and 1430 polyps without metal clips.2.A total of 42 polyps were removed in 25 patients with delayed hemorrhage,with a bleeding rate of 1.3%(42/3240).The bleeding rate of patients with hypertension was 3.4%(18/529),and the bleeding rates of polyps with the size of0.5-0.9cm,1.0-1.9cm and ≥2.0cm were 0.7%,2.4% and 2.6%,respectively.The bleeding rate of polyps located in cecum and ascending colon was 2.8%(26/927).The bleeding rates of other parts were 0.9%(6/704)in transverse colon,0% in descending colon,0.5%(4/834)in sigmoid colon and 1.1%(6/571)in rectum.The bleeding rate of pedicled polyps was 2.7%(32/1196),and that of sessile polyps was 0.5%(10/2044).The bleeding rate of adenomatous polyps was 1.4%(34/2394),and that of non-adenomatous polyps was 0.9%(8/846).3.Univariate and multivariate analysis of patients’ general conditions and polypo-related data showed that hypertension(OR = 4.061,95%CI 2.041-8.082,P =0.001),polyp size ≥1.0cm(OR = 3.155,95%CI 1.543-6.454,P = 0.002),polyps located in cecum and ascending colon(OR = 3.766,95%CI 1.466-9.676,P = 0.006)and pedicled polyps(OR = 3.798,95%CI 1.773-8.137,P = 0.002)were independent risk factors for delayed postpolypectomy bleeding.4.There was a significant difference in the rate of late bleeding between the metal clip group and the non-metal clip group(0.9% VS 1.7%,P=0.043).Conclusions:1.With hypertension,cecum and ascending colon polyp,polyp size ≥1.0cm and pedicled polyp are independent risk factors for delayed postpolypectomy bleeding.2.Prophylactic application of metal clip can effectively reduce the incidence of delayed bleeding. |
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