Establishment of a model for predicting delayed post-polypectomy bleeding: A real-world retrospective study

A dynamic online nomogram for predicts delayed postoperative bleeding after colorectal polyp surgery

This study aims to analyze the risk factors associated with delayed postoperative bleeding (DPPB) following colorectal polyp surgery, develop a dynamic nomogram and evaluate the model efficacy, provide a reference for clinicians to identify the patients at high risk of DPPB. Retrospective study was done on patients who underwent endoscopic colorectal polypectomy at the First Hospital of Lanzhou University from January 2020 to March 2023. Differences between the group with and without DPPB were compared, and independent risk factors for DPPB occurrence were identified through univariate analysis and combination LASSO and logistic regression. A dynamic nomogram was constructed based on multiple logistic regression to predict DPPB following colorectal polyp surgery. Model evaluation included receiver operating characteristic (ROC), Calibration curve, Decision curve analysis (DCA). DPPB occurred in 38 of the 1544 patients included. multivariate analysis showed that direct oral anticoagulants (DOACs), polyp location in the right hemi colon, polyp diameter, drink, and prophylactic hemoclips were the independent risk factors for DPPB and dynamic nomogram were established. Model validation indicated area under the ROC curve values of 0.936, 0.796, and 0.865 for the training set, validation set, and full set, respectively. The calibration curve demonstrated a strong alignment between the predictions of the column-line diagram model and actual observations. The decision curve analysis (DCA) displayed a significant net clinical benefit across the threshold probability range of 0-100%. The dynamic nomogram aids clinicians in identifying high-risk patients, enabling personalized diagnosis and treatment.

The Effectiveness of Prophylactic Epinephrine Compared to No Prophylaxis for Postpolypectomy Bleeding in Endoscopic Colorectal Surgery: A Systematic Review and Meta-Analysis

Colorectal cancer prevention has seen significant advancements with colonoscopic polypectomy, a critical technique in clinical practice. However, postpolypectomy bleeding (PPB), particularly in the resection of large pedunculated polyps, remains a major complication. This systematic review and meta-analysis investigates the efficacy of prophylactic epinephrine injections in preventing PPB, addressing inconsistencies in the literature regarding its effectiveness. Employing a comprehensive search strategy, we rigorously selected studies for inclusion, focusing on those comparing prophylactic epinephrine with no intervention. The risk of bias was assessed using the Cochrane Risk of Bias assessment tool, ensuring a robust and reliable analysis. Our findings, based on an analysis of four studies involving 1,062 patients, indicate a significant reduction in early PPB with epinephrine use, with a marked decrease in bleeding incidence compared to the no-prophylaxis group. However, the impact on delayed bleeding was less conclusive, suggesting the need for further research in this area. Our study thus highlights the effectiveness of epinephrine as a preventive tool in colonoscopic polypectomy while underscoring the complexity of bleeding risks and the necessity for ongoing investigation in optimizing patient outcomes.

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

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.