Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions

Abstract

Proximal lesion location is a highly significant risk for clinically significant delayed bleeding following colonic EMR, and this knowledge could form the basis of a targeted therapeutic trial. Recent aspirin use also increases bleeding risk--specific consensus guidelines in this area are required for colonic EMR.

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

“…[25][26][27][28] Studies of aspirin in the context of ESD 29 30 or large (>20 mm) colonic EMRs [31][32][33] have found an increased risk of haemorrhage; EMR in the upper gastrointestinal tract confers a high risk of haemorrhage, but there are no studies on continuous aspirin therapy. The thrombotic risk to the patient should also be considered, particularly in those receiving aspirin for secondary prevention as they are at greater risk from discontinuation of therapy than those taking it for primary prevention.…”

“…[31][32][33] Pooled analysis of the results in 1807 patients showed that clinically significant post-EMR bleeding was associated with the use of aspirin; only 20 patients were on clopidogrel so that no conclusion can be drawn for clopidogrel. No data are available regarding the use of prasugrel, ticagrelor or DOACs in relation to colonic EMR.…”

Predictive factors for complications in endoscopic resection of large colorectal lesions: a multicenter prospective study

“…According to the literature, the rate of post procedure bleeding after CER is reported to be between 0.4 and 7.0 % although the size of the subject lesions was varied [17][18][19]. In the present study, the post procedure bleeding rate for colorectal lesions sized ]20 mm was 1.6 %.…”

Rectal Carcinoma: Multi-Modality Approach in Curative Local Treatment of Early Rectal Carcinoma

“…A retrospective study by Kim et al (2011) reported that 7 out of the 65 patients with submucosal cancer who underwent EMR showed adverse outcomes within 3 years: recurrence or residual of primary cancer or lymph node metastasis. Metz et al (2011) reported 7% (21 out of 288 patients) experienced clinically significant delayed bleeding after undergoing EMR for laterally spreading tumours of 20mm or greater. 10 underwent colonoscopy, 1 required angiography and 1 required surgery after perforation following hemostatic clip placement.…”