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Risk factors for delayed bleeding after endoscopic submucosal dissection of colorectal tumors

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Abstract

Aim

To investigate the risk factors for delayed bleeding following endoscopic submucosal dissection (ESD) for colorectal neoplasms.

Methods

We retrospectively reviewed the medical records of 991 consecutive patients who underwent ESD for colorectal neoplasms at our hospital from January 2007 to November 2016. Delayed post-ESD bleeding was defined as bleeding within 6 h to 30 days after ESD that resulted in either of the three situations: overt hematochezia, bleeding spots confirmed by repeat colonoscopy, or the requirement of a blood transfusion. Delayed bleeding was furtherly separated into early and late delayed bleeding by the end of post-ESD day 2. We analyzed the relationship between delayed bleeding and candidate factors including patient-, lesion-, and treatment-related details.

Results

Delayed post-ESD bleeding was found in 47 patients (4.7%), of which 18 cases were late delayed bleeding. Among all patients, 14 patients required a second colonoscopy, and 2 other patients were transferred to surgery. Univariate analysis revealed that patients with hypertension (p = 0.017) and using hot biopsy forceps for wound management (p = 0.028) were significantly associated with late delayed bleeding. Both risk factors remained significant after multivariate analysis: hypertension (OR 2.829, 95% CI 1.101–7.265, p = 0.031), hot biopsy forceps (OR 2.873, 95% CI 1.013–8.147, p = 0.047). Using hot biopsy forceps was also the significant risk factor for late delayed bleeding compared with early delayed bleeding.

Conclusion

Patient with hypertension and using hot biopsy forceps for wound management during procedure call for attention on high risk of delayed post-ESD bleeding. Therefore, additional perioperative treatment is recommended in patients with these risk factors.

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Funding

Grant Support: This project was supported by the Shanghai Engineering and Research Center of Diagnostic and Therapeutic Endoscopy (16DZ2280900), the National Natural Science Foundation of China (81672329), Science and Technology Commission Foundation of Shanghai Municipality (16411950400, 16411950406), and Shanghai Municipal Health System Outstanding Academic Leaders Foundation Program (2017BR010).

Author information

Author notes

  1. Ran Li, Shilun Cai and Di Sun contribute equally to this paper.

Authors and Affiliations

  1. Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai, 200032, China

    Ran Li, Shilun Cai, Di Sun, Qiang Shi, Zhong Ren, Zhipeng Qi, Bing Li, Liqing Yao, Meidong Xu, Pinghong Zhou & Yunshi Zhong

  2. Endoscopy Research Institute of Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Ran Li, Shilun Cai, Di Sun, Qiang Shi, Zhong Ren, Zhipeng Qi, Bing Li, Liqing Yao, Meidong Xu, Pinghong Zhou & Yunshi Zhong

Authors
  1. Ran Li
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  2. Shilun Cai
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  3. Di Sun
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  4. Qiang Shi
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  5. Zhong Ren
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  7. Bing Li
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  9. Meidong Xu
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  10. Pinghong Zhou
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  11. Yunshi Zhong
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Corresponding author

Correspondence to Yunshi Zhong.

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Disclosures

Ran Li, Shilun Cai, Di Sun, Qiang Shi, Zhong Ren, Zhipeng Qi. Bing Li, Liqing Yao, Meidong Xu, Pinghong Zhou, Yunshi Zhong have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki, and the Institutional Review Board of Zhongshan Hospital Fudan University approved the study protocol.

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Li, R., Cai, S., Sun, D. et al. Risk factors for delayed bleeding after endoscopic submucosal dissection of colorectal tumors. Surg Endosc 35, 6583–6590 (2021). https://doi.org/10.1007/s00464-020-08156-5

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  • DOI: https://doi.org/10.1007/s00464-020-08156-5

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