Original articleAlimentary tractA Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions
Section snippets
Patients
The Spanish EMR Group, formed by endoscopists from 23 Spanish hospitals, started a multicenter prospective observational study in February 2013. Nonpedunculated colorectal lesions 2 cm or larger that underwent EMR were recorded consecutively in a centralized database. All patients who had indications for EMR of colorectal lesions were screened for inclusion. Subjects who refused to participate in the study and/or had lesions smaller than 20 mm were excluded. Until February 2015, we collected
General Characteristics of Patients and Lesions
A total of 1255 EMRs of large colorectal lesions were performed consecutively in 1214 patients (Table 1). There were 770 (63.4%) males and their mean age was 67.9 years (range, 24–93 y). The American Society of Anesthesiologists (ASA) score was III or IV in 379 patients (30.5%). A total of 218 (17.5%) patients had antiplatelet therapy prescribed. Aspirin treatment was used during the procedure in 51 patients (4.1%).
The mean lesion size was 30.5 mm (SD, 11.82 mm; range 20–120 mm). Lesion
Discussion
In this multicenter prospective cohort we found that factors associated with DB were patient age 75 years and older, ASA classification of III or IV, aspirin use during EMR, location of the lesion proximal to the transverse colon, a lesion size of 40 mm or larger, and no complete mucosal closure with clips. On the basis of these risk factors, we developed a DB scoring system for EMR of large colorectal lesions.
The risk factors we found to be associated with DB have been described in other
Conclusions
In this large, prospective, multicenter series, 6 simple variables (age, ≥75 y; ASA classification III or IV, aspirin use during EMR, location of lesion proximal to the transverse colon, lesion size ≥40 mm, and no mucosal complete closure with clips) were associated with DB after EMR. We developed a predictive score to estimate the DB risk that could be used in the management of these patients to guide the prophylactic treatment and observation period. It also might be useful in clinical trials
Acknowledgments
The authors would like to acknowledge Carolyn Newey for help in editing the manuscript and Navarrabiomed-Fundación Miguel Servet for their support with the statistical analysis.
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Conflicts of interest The authors disclose no conflicts.