Analysis Of Factors Related To Delayed Bleeding After Endoscopic Resection Of Colorectal Polyps

Background Delayed post-polypectomy bleeding（DPPB）is a common complication after colonoscopy polypectomy.In recent years,with endoscopic technology,operation mode gradually improved and perioperative management,strictly DPPB incidence has a downward trend,but there are still some postoperative incidence of delayed hemorrhages,severe cases can endanger patient life.The purpose of this study was to identify patients at high risk of DPPB by analyzing the factors associated with delayed bleeding,and to provide endoscopy practitioners with a valuable assessment of bleeding risk.Objective In this study,the clinical data of patients undergoing colorectal polypectomy were retrospectively studied to explore the risk factors related to delayed bleeding after colonoscopic polypectomy,and to compare and analyze the correlation between the risk factors and delayed bleeding.Methods: A total of 5877 patients admitted to the Department of Gastroenterology of Henan Provincial People’s Hospital from January 2018 to December 2019 who were diagnosed with colorectal polyp and underwent electronic colonoscopic polypectomy were selected as the study subjects.Clinical data including general information,endoscopic reports,clinical manifestations and prognosis of the patients were retrospectively collected.The study subjects were patients with delayed bleeding after colonoscopy.No postoperative bleeding patients as control group,the case group and control group by propensity score matching selection 1:3 according to the proportion of the control group.Comparative analysis of two groups of patients with clinical data,analysis of colorectal polyp endoscopic treatment of the related risk factors for postoperative bleeding.Results A total of 5877 patients received colorectal polypectomy in our department,of which 101 patients experienced delayed bleeding after surgery,with a delayed bleeding rate of 1.72%,of which 75 cases were mild bleeding.The bleeding stopped after conservative treatment such as fasting and drug hemostasis,and 26 cases were severe bleeding.Emergency endoscopic hemostasis was performed,including one patient with secondary endoscopic hemostasis,and all the other patients successfully hemostasis at one time.No patient was transferred to surgery or interventional therapy,and no patient died.Bleeding occurred mostly within 2 days after surgery（73.3%）,and the average bleeding time was 2 days.Delayed hemorrhages general clinical data for the single factor analysis,results show that the two groups in the history of smoking history（P = 0.004）,drinking（P < 0.001）,high blood pressure has significant difference（P = 0.005）.There were significant differences in polyp morphology（P <0.001）,size（P < 0.001）,number（P =0.013）,surgical method（P< 0.001）,intraoperative bleeding（P =0.001）and preventive measures（P<0.001）in univariate analysis of polyp correlation.But the platelet count,diabetes,coronary heart disease,hyperlipidemia,antithrombotic drug use,the polyp position,P > 0.05,case group and control group did not see obvious correlation.Further to the single factor analysis of P< 0.05 variables（smoking,drinking,hypertension,polyps form,number of polyps,surgical procedure,whether the whole block resection,whether intraoperative bleeding,preventive measures）into the multi-factor logistic regression analysis,the analysis results show that drinking（OR 2.501,95% CI,1.328-4.708;P =0.005）,hypertension（OR 1.847,95%CI,1.032 3.306;P =0.039）and polyp size（OR=17.793,95%CI,1.255~252.281;P =0.033）and number of polyps（OR=2.630,95%CI,1.399~4.946;P =0.003）and surgical method（P < 0.001）were independent risk factors for delayed bleeding after polypectomy.For EMR group（OR 8.781,95%CI,2.880~26.770;P < 0.001）,ESD group（OR value 132.592,95%CI,2.584~6802.410;P =0.015）and mixed resection group（OR 3.402,95%CI,1.517~7.631;P=0.003）,the bleeding risk was higher than APC group.For the comparison of polyp size,polyp > 2cm（OR=17.793,95%CI,1.255~252.281;P =0.033）had a higher risk of bleeding than small polyps.The rest of the factors,such as whether antithrombotic drug application,prevention measures and overall removal,such as high blood pressure,polyp morphology,PT was found and postoperative delayed hemorrhages have obvious correlation.Multivariate analysis showed that alcohol consumption,hypertension,surgical method,number of polyps,and size of polyps were independent risk factors for delayed postoperative bleeding.ROC curve was drawn based on the above data,and the corresponding area under the curve was 0.617,0.573,0.720,0.610,and 0.604.Conclusion Alcohol consumption,hypertension,polyp size,surgical method and number of polyps were independent risk factors for DPPB after polypectomy.