Incidence and risk factors of colonoscopic post‐polypectomy bleeding and perforation in patients with end‐stage renal disease

Yang, Shih‐Cheng; Wu, Cheng‐Kun; Tai, Wei‐Chen; Liang, Chih‐Ming; Li, Yuchi; Yeh, Wen‐Shuo; Lee, Chen‐Hsiang; Yang, Ya‐Chen; Tsai, Tzu‐Hsien; Hsu, Chien‐Ning; Chuah, Seng‐Kee

doi:10.1111/jgh.14969

Cited by 9 publications

(6 citation statements)

References 39 publications

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“…Vascular endothelial dysfunction in hypertensive disease, often accompanied by arteriosclerosis, is accompanied by fluctuating blood pressure and hemodynamic instability in hypertensive disease, which may lead to rupture of small blood vessels in the surface of a wound. [ 24 ] Vessels at the mucous membrane of large intestine in diabetic patients are brittle, and can easily result in bleeding and poor postoperative healing, [ 25 ] which is prone to delayed bleeding. This may be related to the factors such as microangiopathy, blood rheological changes, and the abnormalities of anticoagulant fibrinolytic system caused by diabetic metabolic disorders.…”

Section: Discussionmentioning

confidence: 99%

Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps

Li,

Yu,

Wang

et al. 2023

Medicine

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This study aimed to assess the effectiveness of Endoscopic Mucosal Resection (EMR) and Argon Plasma Coagulation (APC) as therapeutic approaches for intestinal polyps in patients, and to examine the factors associated with postoperative bleeding. This study included 132 patients diagnosed with colorectal polyps (188 polyps) who underwent endoscopic surgery at our hospital between January 2022 and December 2022. Based on the surgical method employed, the patients were divided into 2 groups: EMR (68 cases, 97 polyps) and APC (64 cases, 91 polyps). Comparative analyses were conducted to assess the clinical efficacy, surgery-related indicators, and quality of life the 2 groups. Furthermore, an investigation was carried out to identify the factors associated with postoperative bleeding. The analysis revealed no statistically significant difference in the cure rate of flat and superficial raised polyps between the EMR group and the APC (P > .05). However, it was found that the EMR group exhibited a significantly higher cure rate for subpedunculated and raised-pedunculated polyps compared to the APC group (P < .05). The results of logistics analysis showed that patients with hypertension (OR = 2.876, 95% CI: 1.119–7.393), patients with diabetes (OR = 5.278, 95% CI: 1.388–20.064), patients with hyperlipidemia (OR = 2.594, 95% CI: 1.054–6.380), the polyps of right hemicolon (OR = 2.743, 95% CI: 1.003–7.504), rectal polyps (OR = 5.143, 95% CI: 1.728–7.504), pedunculated polyps (OR = 4.758, 95% CI: 1.322–17.129), adenomatous polyps (OR = 3.152, 95% CI: 1.018–9.757) were independent risk factors for postoperative bleeding in patients with colorectal polyps (P < .05). The findings suggest that for subpedunculated and pedunculated-raised polyps, EMR can be a suitable treatment approach. On the other hand, flat and superficial-raised polyps can be effectively managed with either EMR or APC. The presence of hypertension, diabetes, hyperlipidemia, polyps of the right hemicolon, rectal polyps, pedunculated polyps, and adenomatous polyps has been established as independent risk factors for postoperative bleeding in patients with colorectal polyps.

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Section: Discussionmentioning

confidence: 99%

Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps

Li,

Yu,

Wang

et al. 2023

Medicine

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“…A recent large national cohort study reported that the rates of post-polypectomy bleeding among patients with ESRD were much higher compared with those without ESRD (bleeding: 5.58% vs. 1.75%; P < 0.01). [ 14 ] For this reason, safe colon polypectomy was more important in ESRD patients. In the general population, several studies reported that the immediate bleeding rate with CSP and EMR was 1.77%–6.61% and 0%–3.30%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…[ 15 ] Yang et al . [ 14 ] reported that the rates of post-polypectomy perforation among ESRD patients were significantly higher compared with those among non-ESRD patients (0.28% vs. 0.04%; P < 0.01). CSP does not require an electrosurgical unit.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of cold snare polypectomy and endoscopic mucosal resection for 3–10-mm colorectal polyps in end-stage renal disease patients

Choi

Cho

2022

Saudi Journal of Gastroenterology

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Background: Patients with end-stage renal disease (ESRD) have a higher incidence of clinically relevant complications, such as bleeding and perforation after polyp resection, compared to patients without underlying diseases. Cold snare polypectomy (CSP) is increasingly used for the removal of small polyps and diminutive polyps due to its shorter procedure time and low risk of bleeding and perforation. However, there have been few studies on the effectiveness and safety of CSP in patients with ESRD. The aim of this study was to compare the efficacy and safety of CSP and endoscopic mucosal resection (EMR) in ESRD patients. Methods: This study was a retrospective study. We performed propensity score-matched analysis in patients with ESRD who underwent endoscopic resection for 3–10-mm-sized colorectal polyps at Seoul St. Mary's Hospital, from January 2014 to December 2019. Results: After 1:1 ratio matching, 406 polyps were included: 203 polyps were resected with CSP and 203 polyps with EMR. There was no difference between the CSP group and EMR group in incomplete resection rate (4.43% vs. 1.97%, P = 0.16). There were no differences between the CSP and EMR group for immediate bleeding (5.42% vs. 7.88%, P = 0.32) and delayed bleeding (0% vs. 0.49%, P = 1.00). No perforation occurred in either group. Conclusions: There were no differences between the CSP and EMR group in terms of efficacy and safety. CSP can be one of the standard methods for the removal of 3–10-mm-sized colorectal polyps in patients with ESRD.

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“…Digestive tract cancer (IR 68.9 per 10,000) was the most frequent cancer and the five most common sub-sites included the colorectum, lung, liver, stomach, and kidney. Screening for colorectal cancer using endoscopy in this clinical population is often considered to increase the risk of complications associated with the bowel cleansing preparation and with the procedure itself [18][19][20] . However, for ESKD patients with long life expectancies, colonoscopy for cancer screening should be considered with caution.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological characteristics of cancers in patients with end-stage kidney disease: a Korean nationwide study

Lee

Park

et al. 2021

Sci Rep

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Patients with end-stage kidney disease (ESKD) have been reported to have an increased risk of cancer. However, the epidemiological characteristics of cancer in ESKD patients remain unclear. Therefore, this study aimed to investigate the epidemiological characteristics of cancer in ESKD patients and the differences based on the renal replacement therapy provided. Data on ESKD patients were obtained from the South Korean nationwide cohort Health Insurance Review and Assessment Service database. This study included 58,831 eligible patients of the total 813,907 patients diagnosed with ESKD between January 1, 2007 and December 31, 2017. Of the 58,831 ESKD patients, 3292 (5.6%) were newly diagnosed with cancer. The average duration between the diagnosis of ESKD and cancer was 3.3 ± 1.9 years (mean ± standard deviation), with no differences between hemodialysis, peritoneal dialysis, and kidney transplant groups. The most commonly observed cancer sites in ESKD patients were the colorectum, lung, and liver. The incidence of cancer increased progressively among patients undergoing kidney transplant, peritoneal dialysis, and hemodialysis in that order. Hemodialysis patients were found to have an increased risk of digestive tract cancer compared with kidney transplant patients (adjusted hazard ratio = 1.9; 95% confidence interval: 1.31–2.81; P < 0.001). The study findings may be a useful reference for cancer-screening guidelines.

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Incidence and risk factors of colonoscopic post‐polypectomy bleeding and perforation in patients with end‐stage renal disease

Cited by 9 publications

References 39 publications

Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps

Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps

Comparison of cold snare polypectomy and endoscopic mucosal resection for 3–10-mm colorectal polyps in end-stage renal disease patients

Epidemiological characteristics of cancers in patients with end-stage kidney disease: a Korean nationwide study

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