A systematic description of the post-EMR defect to identify risk factors for clinically significant post-EMR bleeding in the colon.

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A systematic description of the post-EMR defect to identify risk factors for clinically significant post-EMR bleeding in the colon.

Gastrointest Endosc. 2018 Nov 29;:

Authors: Desomer L, Tate DJ, Bahin FF, Chiang B, Awadie H, Holt B, Byth K, Bourke MJ

Abstract
INTRODUCTION: and Aims: Clinically significant bleeding (CSPEB) is the most frequent serious adverse event after endoscopic mucosal resection (EMR) of large laterally spreading colonic lesions (LSLs). There is no proven prophylactic therapy, and it remains a significant drawback of EMR. We aimed to systematically describe and evaluate the features of the post-EMR mucosal defect (PED) and their relationship to CSPEB.
METHODS: A prospective study of LSLs referred for EMR at a tertiary centre was performed. PEDs without visible features were recorded as bland blue (BB). Non-bland blue (NBB) PED features included size, number and herniation of submucosal vessels and presence of submucosal haemorrhage, fibrosis, fat, and exposed muscle. NBB PEDs were analyzed for association with CSPEB, defined as bleeding occurring after completion of the procedure necessitating re-admission or re-intervention.
RESULTS: From April 2012 to May 2017, 501 lesions in 501 patients were eligible for analysis. The frequency of CSPEB was 30 of 501 (6.0%). More than or equal to 3 visible vessels was a significant predictor of CSPEB (P = .016). None of the following showed a significant correlation with CSPEB: presence of visible vessels, their diameter, herniation, nor other nonvascular PED features. Submucosal vessels were more common in the left colon segment (88.6% vs 78.3%, P = .004), and were significantly larger (20.8% vs 12.1% ≥1 mm, P = .037), more numerous (median 4 (IQR 2-7) vs 2 (IQR 1-4), P < .001) vessels, P < .001) and more often herniated (32% vs 22.2%, P = .022).
CONCLUSION: More than or equal to 3 visible vessels within the post-EMR defect may be predictive for CSPEB and may define a target group for real-time prophylactic intervention. No other endoscopically visible features of the PEDs were predictive of CSPEB. NCT03117400.

PMID: 30503846 [PubMed - as supplied by publisher]

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