The Risk Factors Of Delayed Postpolypectomy Bleeding And Its Treatment

Objections:Nowadays,endoscopic treatment as an effective method of colonic polypectomy has been widely used in clinic.It can effectively reduce the incidence of colorectal cancer.But it is also accompanied by a series of complications such as delayed bleeding,electrocoagulation syndrome,perforation,infection,etc.The delayed bleeding is a common complication after colonic polypectomy.Previous study showed that the incidence was 0.2?6.1%.Studies have also shown that the size of polyps and the experience of endoscopic physicians are all the factors that affect delayed bleeding.In our study,we aimed to analyze risk factors of delayed postpolypectomy bleeding(DPPB).Endoscopic therapy is an effective method to treat delayed bleeding.However,some patients with conservative treatment also achieved good results.This study further discusses the choice of endoscopic therapy or conservative treatment for DPPB.Methods:1.Retrospective analysis of the endoscopic data of 3171 polypectomy cases taken from the First Affiliated Hospital of Zhejiang University from January 2010 to December 2015.Collect the information of patients' age,gender,polyp position,endoscopic therapy method,intraoperative bleeding,intraoperative titanium-clip treatment,hypertension,diabetes,hyperlipidemia,coronary heart disease to analysis the risk factors of DPPB.2.In this study,we analyaed the information of 70 DBBP patients.Conservative treatment was used in 34 patients,and endoscopic therapy was performed on the other 36 patients to hemostatic.Both groups had good prognosis.By analyzing the information of the amount of bleeding,hemoglobin and fibfinogen loss after bleeding,intraoperative titanium-clip treatment,gender,hyperlipidemia,hypertension of the two groups,we expect to find an better choice of endoscopic therapy and conservative treatment for DPPB.Results:1.In this study,the incidence of DPPB was 2.3%(73/3171).The risk factors of DPPB include intraoperative bleeding(OR 4.372 95%CI 3.192?7.342,p<0.05),hyperlipidemia(OR 2.26 95%CI 1.305?3.524,p<0.05),hypertension(OR 4.72 95%CI 2.63?7.27,p<0.05),polyp position and endoscopic therapy method.The study shows that the right colon polyp(OR 1.83 95%CI 1.26?2.71,p<0.05),rectal polyp(OR 1.58 95%CI 1.24?1.67,p<0.05)are the risk factors of DPPB.Compared with the other endoscopic therapy method,EMR(OR 1.73 95%CI1.09?2.21,P<0.05)and ESD(OR 2.87 95%CI 1.86?3.14,p<0.05)increased the risk of DPPB.There was no statistically significant difference in gender,age,intraoperative titanium-clip treatment,diabetes and coronary heart disease to the increased risk of DPPB.2.By comparing the patients with conservative treatment and endoscopic therapy,the study showed that the amount of bleeding?100ml(OR 127 95%CI 21.77?746.6,p<0.05),the decrease of HB>12.3g/L or the decrease of FIB>0.32g/L,which could all be considered as the basis for selecting endoscopic therapy.Meanwhile male patients(OR 5.248 95%CI 1.804?15.26,p<0.05)with delayed bleeding were more likely to choose endoscopic therapy.Conclusion:1.Intraoperative bleeding,hypertension,hyperlipidemia,the right colon polyp and rectal polyp are the independent risk factors of DPPB.Compared with the other endoscopic therapy method,EMR and ESD increased the risk of DPPB.2.In patients with DPPB,when amount of bleeding?100ml,the decrease of HB>12.3g/L and the decrease of FIB>0.32g/L should be considered as the basis for selecting endoscopic therapy.And male patients were more likely to choose endoscopic therapy.