Factors associated with increased bleeding post‐endoscopic mucosal resection

Abstract

In experienced hands bleeding during and after EMR appears to be uncommon. Larger lesions are at increased risk of early and delayed bleeding.

A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions

“…5,32 In our series, the DB rate in the 50 patients (4.1%) who had aspirin treatment during EMR was 12%, and aspirin therapy during EMR added 2 points to our DB risk score, whereas other large observational studies did not find aspirin therapy was a risk factor. 6,30,31 Our findings regarding lesion location and size association with DB are well supported in the literature. First, the proximal colonic location of the lesion clearly is associated with DB in many studies, 5,8,20,25,26 including a randomized controlled trial of 347 EMRs of large colorectal nonpedunculated lesions 13 and a large observational study of 1172 patients.…”

“…2,3 Several features have been established as risk factors for DB, such as large lesions and location in the proximal colon, but others remain controversial. 2,[4][5][6][7][8] To prevent DB, several strategies commonly are used, such as adding adrenaline to the submucosal injection solution, [9][10][11] applying argon plasma coagulation or coagulation forceps on nonbleeding visible vessels, 12,13 and clipping to close the resection mucosal defect. Scientific evidence for all of these prevention strategies is scarce, and guidelines for prevention are lacking.…”

Clip Closure Prevents Bleeding After Endoscopic Resection of Large Colon Polyps in a Randomized Trial

“…[5][6][7][8][9][10][11][12][13] A few prior studies have suggested a benefit of closing the mucosal defect following the polyp resection, 12,13,18 whereas others have not. 27,28 However, these studies were limited by retrospective design, 12,27,28 lack of a control group, 13 potential bias for patient selection, 12,13,28 inclusion of smaller polyps, 18 use of variable resection techniques, 18 and unclear definition of outcomes. 18 In contrast, our trial was methodologically rigorous, adequately powered, and all polyps were removed by EMR, which is considered the standard technique for large colon polyps in Western countries.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…106 107 Duodenal EMR had the highest risk of delayed bleeding. In two retrospective observational studies of duodenal EMR, delayed bleeding was reported in 14/ 113 (12.3%) 103 and 7/111 patients (6.3%) 106 despite the prophylactic use of endoclips in 82% of cases in the latter.…”

“…32 In one study, oesophageal EMR presented a greater risk of IPB compared with duodenal or colonic EMR. 106 Nevertheless the rate of delayed post-EMR bleeding in the oesophagus remains low (0.6-0.9%), even in studies that include a high proportion of patients with a temporary cessation of antiplatelet therapy. 106 107 Duodenal EMR had the highest risk of delayed bleeding.…”