Clinical outcome of endoscopic management in delayed postpolypectomy bleeding
Background/Aims: The clinical course after endoscopic management of delayed postpolypectomy bleeding (DPPB) has not been clearly determined. This study aimed to assess clinical outcomes after endoscopic hemostasis of DPPB and evaluate risk factors for rebleeding after initial hemostasis.Methods: We...
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| Format: | Article |
| Language: | English |
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Korean Association for the Study of Intestinal Diseases
2017-04-01
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| Series: | Intestinal Research |
| Subjects: | |
| Online Access: | https://doi.org/10.5217/ir.2017.15.2.221 |
| _version_ | 1828923228679045120 |
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| author | Jeong-Mi Lee Wan Soo Kim Min Seob Kwak Sung-Wook Hwang Dong-Hoon Yang Seung-Jae Myung Suk-Kyun Yang Jeong-Sik Byeon |
| author_facet | Jeong-Mi Lee Wan Soo Kim Min Seob Kwak Sung-Wook Hwang Dong-Hoon Yang Seung-Jae Myung Suk-Kyun Yang Jeong-Sik Byeon |
| author_sort | Jeong-Mi Lee |
| collection | DOAJ |
| description | Background/Aims: The clinical course after endoscopic management of delayed postpolypectomy bleeding (DPPB) has not been clearly determined. This study aimed to assess clinical outcomes after endoscopic hemostasis of DPPB and evaluate risk factors for rebleeding after initial hemostasis.Methods: We reviewed medical records of 198 patients who developed DPPB and underwent endoscopic hemostasis between January 2010 and February 2015. The performance of endoscopic hemostasis was assessed. Rebleeding negative and positive patients were compared.Results: DPPB developed 1.4±1.6 days after colonoscopic polypectomy. All patients achieved initial hemostasis. Clipping was the most commonly used technique. Of 198 DPPB patients, 15 (7.6%) had rebleeding 3.3±2.5 days after initial hemostasis. The number of clips required for hemostasis was higher in the rebleeding positive group (3.2±1.6 vs. 4.2±1.9, P=0.047). Combinations of clipping with other modalities such as injection methods were more common in the rebleeding positive group (67/291, 23.0% vs. 12/17, 70.6%; P<0.001). Multivariate analysis showed a large number of clips and combination therapy were independent risk factors for rebleeding. All the rebleeding cases were successfully managed by repeat endoscopic hemostasis.Conclusions: Endoscopic hemostasis is effective for the management of DPPB because of its high initial hemostasis rate and low rebleeding rate. Endoscopists should carefully observe patients in whom a large number of clips and/or combination therapy have been used to manage DPPB because these may be related to the severity of DPPB and a higher risk of rebleeding. |
| first_indexed | 2024-12-13T22:36:48Z |
| format | Article |
| id | doaj.art-ad41473fb065468fb04ce9cb75d86e9d |
| institution | Directory Open Access Journal |
| issn | 1598-9100 |
| language | English |
| last_indexed | 2024-12-13T22:36:48Z |
| publishDate | 2017-04-01 |
| publisher | Korean Association for the Study of Intestinal Diseases |
| record_format | Article |
| series | Intestinal Research |
| spelling | doaj.art-ad41473fb065468fb04ce9cb75d86e9d2022-12-21T23:28:58ZengKorean Association for the Study of Intestinal DiseasesIntestinal Research1598-91002017-04-0115222122710.5217/ir.2017.15.2.221ir.2017.15.2.221Clinical outcome of endoscopic management in delayed postpolypectomy bleedingJeong-Mi Lee0Wan Soo Kim1Min Seob Kwak2Sung-Wook Hwang3Dong-Hoon Yang4Seung-Jae Myung5Suk-Kyun Yang6Jeong-Sik Byeon7Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Background/Aims: The clinical course after endoscopic management of delayed postpolypectomy bleeding (DPPB) has not been clearly determined. This study aimed to assess clinical outcomes after endoscopic hemostasis of DPPB and evaluate risk factors for rebleeding after initial hemostasis.Methods: We reviewed medical records of 198 patients who developed DPPB and underwent endoscopic hemostasis between January 2010 and February 2015. The performance of endoscopic hemostasis was assessed. Rebleeding negative and positive patients were compared.Results: DPPB developed 1.4±1.6 days after colonoscopic polypectomy. All patients achieved initial hemostasis. Clipping was the most commonly used technique. Of 198 DPPB patients, 15 (7.6%) had rebleeding 3.3±2.5 days after initial hemostasis. The number of clips required for hemostasis was higher in the rebleeding positive group (3.2±1.6 vs. 4.2±1.9, P=0.047). Combinations of clipping with other modalities such as injection methods were more common in the rebleeding positive group (67/291, 23.0% vs. 12/17, 70.6%; P<0.001). Multivariate analysis showed a large number of clips and combination therapy were independent risk factors for rebleeding. All the rebleeding cases were successfully managed by repeat endoscopic hemostasis.Conclusions: Endoscopic hemostasis is effective for the management of DPPB because of its high initial hemostasis rate and low rebleeding rate. Endoscopists should carefully observe patients in whom a large number of clips and/or combination therapy have been used to manage DPPB because these may be related to the severity of DPPB and a higher risk of rebleeding.https://doi.org/10.5217/ir.2017.15.2.221ColonoscopyPostpolypectomy bleedingClipRebleeding |
| spellingShingle | Jeong-Mi Lee Wan Soo Kim Min Seob Kwak Sung-Wook Hwang Dong-Hoon Yang Seung-Jae Myung Suk-Kyun Yang Jeong-Sik Byeon Clinical outcome of endoscopic management in delayed postpolypectomy bleeding Intestinal Research Colonoscopy Postpolypectomy bleeding Clip Rebleeding |
| title | Clinical outcome of endoscopic management in delayed postpolypectomy bleeding |
| title_full | Clinical outcome of endoscopic management in delayed postpolypectomy bleeding |
| title_fullStr | Clinical outcome of endoscopic management in delayed postpolypectomy bleeding |
| title_full_unstemmed | Clinical outcome of endoscopic management in delayed postpolypectomy bleeding |
| title_short | Clinical outcome of endoscopic management in delayed postpolypectomy bleeding |
| title_sort | clinical outcome of endoscopic management in delayed postpolypectomy bleeding |
| topic | Colonoscopy Postpolypectomy bleeding Clip Rebleeding |
| url | https://doi.org/10.5217/ir.2017.15.2.221 |
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