Analysis Of Risk Factors Of Delayed Post-polypectomy Bleeding

Objective: The aim of this study was to identify factors associated with the risk of delayed post-polypectomy bleeding.Methods: This is a retrospective observational study based on the medical data of the endoscopic center of endoscopy Center of our hospital.We reviewed the case records of patients who underwent colonoscopy polypectomy in our hospital from January 2015 to September 2020,compared the differences of multiple factors including patients,polyps and surgery between 72 bleeding patients and 3759 non-bleeding patients,and then analyzed the independent risk factors of delayed post-polypectomy bleeding(DPPB)by logistic regression.Results: In 3831 patients who underwent colonoscopy polypectomy in our hospital,a total of 4968 polyps were removed,and 72 cases(the incidence of DPPB was 1.9%)presented with DPPB.All patients had stanched bleeding successfully without death,of which 37 were treated by endoscopy successfully,and one was transferred to interventional surgery after hemostasis failure,and the remaining 44 cases were treated conservatively.Univariate analysis showed that there were significant differences in hypertension(P=0.008),diabetes(P=0.006)and hyperlipidemia(P=0.033)between the hemorrhage group and the control group,and there were significant differences in polyp related factors between the two groups: polyp location(P=0.028),morphology(P=0.035),pathological type(P=0.016)and the number of polyps removed by one operation(0.014).Among the operation-related factors,the method of operation(Purge P=0.010)had a statistically significant effect on DPPB.The variables that may be related to DPPB were screened out by logistic univariate regression analysis(P < 0.05): hypertension,diabetes,hyperlipidemia,polyp location,morphology,pathological type,number of polyps,mode of operation.Binary logistic multi-factor regression analysis found that hypertension(OR1.890,95%CI 1.087-3.287,P=0.024),diabetes(OR 2.183,95%CI 1.077-4.428,P=0.030),hyperlipemia(OR 1.837,95%CI 1.105-3.056,P=0.019)of the patients more easily than patients without history of related bleeding;The polyps of right colon(OR 1.831,95%CI1.015-3.300,P=0.044)and rectum(OR2.255,95%CI 1.200-4.238,P=0.012)had a higher risk of postoperative bleeding than the left colon;Pediculated polyps were more likely to have postoperative bleeding than sessile polyps(OR 1.755,95%CI 1.076-2.864,P=0.024),and adenomatous polyps were more likely to have delayed post-polypectomy bleeding than non-adenomatous polyps(OR 1.877,95%CI 1.010-3.488,P=0.046).The patients which underwent colonoscopy polypectomy of endoscopic mucosa dissecction(ESD)(OR3.356,95%CI 1.574-7.159,P=0.002)and Endoscopic mucosal resetion(EMR)(OR1.884,95%CI 0.825-4.302,P=0.133)had higher bleeding risk than high frequency electrocoagulation and biopsy forceps(P=0.004).However,gender,age,smoking and drinking history,heart disease,cirrhosis,hepatitis B infection or carrying,hemoglobin level(g/L),colorectal cancer surgery history,oral antithrombotic drugs,polyp single,polyp number,intraoperative titanium-clip treatment,experience of operator were not found to increase the risk of postoperative bleeding.Conclusion: Hypertension,diabetes,hyperlipidemia,right colon and rectal polyps,pedunculated polyps,adenomatous polyps,ESD and EMR treatment methods were independently associated with DPPB.Identifying these factors before operation could make treatment strategies and control in advance and reduce the incidence of DPPB.