Prophylactic endoscopic coagulation to prevent delayed post-EMR bleeding in the colorectum: a prospective randomized controlled trial (with videos)

Lee, Hyun Seok; Kwon, Yong Hwan; Nam, Su Youn; Shin, Seonghwan; Kim, Ryanghi; Ahn, Sang‐Hyeon

doi:10.1016/j.gie.2019.05.039

Cited by 14 publications

(12 citation statements)

References 27 publications

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“…In our hospital, all exposed vessels on the resected ulcer were coagulated with hemostatic forceps in conjunction with a high-frequency generator after colorectal ER. Lee et al [38] reported that prophylactic cautery of visible vessels reduced postcolorectal EMR bleeding. Furthermore, several previous studies reported that closure of mucosal defects with clips after EMR for large colorectal lesions decreased the risk of bleeding after ER [39,40].…”

Section: Discussionmentioning

confidence: 99%

Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis

Inagaki

Yamashita

Oka

et al. 2021

Gastroenterology Research and Practice

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The Japan Gastroenterological Endoscopy Society (JGES) guidelines recommend continued warfarin treatment during gastroenterological endoscopic procedures with a high risk of bleeding as an alternative to heparin replacement in patients on warfarin therapy. However, there is insufficient evidence to support the use of warfarin in colorectal endoscopic resection (ER). The present study is aimed at verifying the risk of bleeding after ER for colorectal neoplasia (CRN) in patients with continued warfarin use. This was a single-center retrospective cohort study using clinical records. We assessed 126 consecutive patients with 159 CRNs who underwent ER (endoscopic mucosal resection, 146 cases; endoscopic submucosal dissection, 13 cases) at Hiroshima University Hospital between January 2014 and December 2019. Patients were divided into two groups: the heparin replacement group (79 patients with 79 CRNs) and the continued warfarin group (47 patients with 80 CRNs). One-to-one propensity score matching was performed to compare the bleeding rate after ER between the groups. The rate of bleeding after ER was significantly higher in the heparin replacement group than in the continued warfarin group for both before (10.1% vs. 1.3%, respectively; P = 0.0178 ) and after (11.9% vs. 0%, respectively; P = 0.0211 ) propensity score matching. None of the patients experienced thromboembolic events during the perioperative period. The risk of bleeding after colorectal ER was significantly lower in patients with continued warfarin use than in those with heparin replacement. Our data supports the recommendations of the latest JGES guidelines for patients receiving warfarin therapy.

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Section: Discussionmentioning

confidence: 99%

Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis

Inagaki

Yamashita

Oka

et al. 2021

Gastroenterology Research and Practice

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“…Another likely contributor is that bleeding at the anorectal junction is readily apparent and easily accessed, therefore predisposing the patient to seek out medical attention and the endoscopist to intervene. Unfortunately, CSPEB remains a major drawback of minimally invasive resection techniques, with prophylactic vessel coagulation53 and prophylactic clip closure54 having limited roles for these specific lesions.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic mucosal resection is effective for laterally spreading lesions at the anorectal junction

Shahidi¹,

Sidhu²,

Vosko

et al. 2019

Gut

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ObjectiveThe optimal approach for removing large laterally spreading lesions at the anorectal junction (ARJ-LSLs) is unknown. Endoscopic mucosal resection (EMR) is a definitive therapy for colorectal LSLs. It is unclear whether it is an effective modality for ARJ-LSLs.DesignEMR outcomes for ARJ-LSLs (distal margin of ≤20 mm from the dentate line) in comparison with rectal LSLs (distal margin of >20 mm from the dentate line) were evaluated within a multicentre observational cohort of LSLs of ≥20 mm. Technical success was defined as the removal of all polypoid tissue during index EMR. Safety was evaluated by the frequencies of intraprocedural bleeding, delayed bleeding, deep mural injury (DMI) and delayed perforation. Long-term efficacy was evaluated by the absence of recurrence (either endoscopic or histologic) at surveillance colonoscopy (SC).ResultsBetween July 2008 and August 2019, 100 ARJ-LSLs and 313 rectal LSLs underwent EMR. ARJ-LSL median size was 40 mm (IQR 35–60 mm). Median follow-up at SC4 was 54 months (IQR 33–83 months). Technical success was 98%. Cancer was present in three (3%). Recurrence occurred in 15.4%, 6.8%, 3.7% and 0% at SC1–SC4, respectively. Among 30 ARJ-LSLs that received margin thermal ablation, no recurrence was identified at SC1 (0.0% vs 25.0%, p=0.002). Technical success, recurrence and adverse events were not different between groups, except for DMI (ARJ-LSLs 0% vs rectal LSLs 4.5%, p=0.027).ConclusionEMR is an effective technique for ARJ-LSLs and should be considered a first-line resection modality for the majority of these lesions.

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“…PEC was associated with significantly decreased risk of DPPB. 91 Alternatives to PEC are also being investigated. A recent RCT by Subramaniam et al assessed the application of a topical haemostatic matrix, Purastat (3D-Matrix Europe Ltd., France) during ESD of oesophageal and colonic lesions 2–5cm, compared with usual electrocautery.…”

Section: Reducing the Risk Of Dppbmentioning

confidence: 99%

Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

Bendall¹,

Ja²,

Pawlak³

et al. 2021

CEG

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Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3–1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summary of factors that contribute to the risk of DPPB before discussing pragmatic interventions to mitigate their risk and improve patient safety.

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Prophylactic endoscopic coagulation to prevent delayed post-EMR bleeding in the colorectum: a prospective randomized controlled trial (with videos)

Cited by 14 publications

References 27 publications

Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis

Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis

Endoscopic mucosal resection is effective for laterally spreading lesions at the anorectal junction

Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

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