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Intra-procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study.

ABSTRACT: Background and aim:The safety of endoscopic resection of large colorectal lesions (LCLs) (?20?mm) is clinically relevant. The aim of the present study was to assess the rate of post-resection adverse events (AEs) in a real-life setting. Patients and methods:In a prospective, multicentre, observational study, data from consecutive resections of LCLs over a 6-month period were collected in 24 centres. Patients were followed up at 15 days from resection for AEs. The primary endpoint was intra-procedural bleeding according to lesion morphology. Secondary endpoints were delayed bleeding and perforation. Patient and polyp characteristics, and polypectomy techniques were analysed with respect to the bleeding events. Results:In total, 1504 patients (female/male: 633/871, mean age, 66.1) with 1648 LCLs (29.1% pedunculated and 70.9% non-pedunculated lesions) were included. Overall, 168 (11.2%) patients had post-resection bleeding (8.5 and 2.0% immediate and delayed, respectively), while 15 (1.0%) cases of perforation occurred. Independent predictors of immediate bleeding for pedunculated lesions were bleeding prophylaxis (odds ratio (OR) 0.28, 95% confidence interval (CI) 0.13-0.62), simple polypectomy (versus endoscopic mucosal resection, OR 0.38, 95% CI 0.17-0.88) and inpatient setting (OR 2.21, 95% CI 1.07-5.08), while bleeding prophylaxis (OR 0.37, 95% CI 0.30-0.98), academic setting (OR 0.27, 95% CI 0.12-0.54) and size (OR 1.03, 95% CI 1.00-1.05) were predictors for those non-pedunculated. Indication for colonoscopy (screening versus diagnostic (OR 0.33, 95% CI 0.12-0.86)), antithrombotic therapy (OR 3.12, 95% CI 1.54-6.39) and size (OR 2.34, 95% CI 1.12-4.87) independently predicted delayed bleeding. Conclusions:A low rate of post-resection AEs was observed in a real-life setting, reassuring as to the safety of endoscopic resection of ?2?cm colorectal lesions. Bleeding prophylaxis reduced the intra-procedural bleeding risk, while antithrombotic therapy increased delayed bleeding.CLINICALTRIAL: (NCT02694120).

SUBMITTER: Amato A

PROVIDER: S-EPMC6893999 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Intra-procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study.

Amato Arnaldo A Radaelli Franco F Correale Loredana L Di Giulio Emilio E Buda Andrea A Cennamo Vincenzo V Fuccio Lorenzo L Devani Massimo M Tarantino Ottaviano O Fiori Giancarla G De Nucci Germana G De Bellis Mario M Hassan Cesare C Repici Alessandro A

United European gastroenterology journal 20190923 10

<h4>Background and aim</h4>The safety of endoscopic resection of large colorectal lesions (LCLs) (≥20 mm) is clinically relevant. The aim of the present study was to assess the rate of post-resection adverse events (AEs) in a real-life setting.<h4>Patients and methods</h4>In a prospective, multicentre, observational study, data from consecutive resections of LCLs over a 6-month period were collected in 24 centres. Patients were followed up at 15 days from resection for AEs. The primary endpoint ...[more]

PMID: 31839962

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Project description:Bleeding complications after percutaneous transcatheter interventions that used large-bore catheters are frequent and associated with high mortality and morbidity.To describe the incidence of bleeding complications among patients undergoing contemporary endovascular interventions involving large-bore catheters and its association with in-hospital mortality, length of stay, and health care cost.This retrospective cohort study analyzed all 17?672 patients from the Healthcare Cost and Utilization Project's National Inpatient Sample database who were recorded as having undergone a transcatheter aortic valve replacement (n?=?3223), an endovascular aneurysm repair (n?=?12?633), or a percutaneous left ventricular assist device implant (n?=?1816) between January 1, 2012, and December 31, 2013. Bleeding complication was defined as any transfusion, any hemorrhage or hematoma, or the need for percutaneous or surgical intervention to control the bleeding event. Health care costs were determined by multiplying the total charge for each visit by the cost to charge ratios reported for each hospital code in the database. Data were collected from the database on April 29, 2016.Adjusted association between bleeding complications and mortality was determined by multivariable logistic regression. Length of stay and total health care costs were compared using multivariable linear regression between patients who did and patients who did not have bleeding complications.Bleeding complications occurred in 3128 patients (17.7%) (1984 men and 1144 women, with a mean [SD] age of 75.6 [11.9] years). Bleeding was associated with higher mortality (adjusted odds ratio, 2.70; 95% CI, 2.27-3.22; P?<?.001) and longer hospital stay (adjusted multiplicative difference, 2.14; 95% CI, 2.06-2.16; P?<?.001). Median (interquartile range) total health care costs were $48?663 ($32?620-$71?547) for patients with bleeding complications compared with $29?968 ($21?924-$43?287) for patients without a bleeding complication (adjusted multiplicative difference, 1.55; 95% CI, 1.52-1.59; P?<?.001).Periprocedural bleeding was common among patients who underwent transcatheter intervention using large-bore catheters and was associated with a statistically significant increase in mortality, length of stay, and cost.

Dataset Information

Intra-procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study.

Publications

Intra-procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study.

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