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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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Autores principales: Lee, Jeong-Mi, Kim, Wan Soo, Kwak, Min Seob, Hwang, Sung-Wook, Yang, Dong-Hoon, Myung, Seung-Jae, Yang, Suk-Kyun, Byeon, Jeong-Sik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association for the Study of Intestinal Diseases 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430015/
https://www.ncbi.nlm.nih.gov/pubmed/28522953
http://dx.doi.org/10.5217/ir.2017.15.2.221
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author Lee, Jeong-Mi
Kim, Wan Soo
Kwak, Min Seob
Hwang, Sung-Wook
Yang, Dong-Hoon
Myung, Seung-Jae
Yang, Suk-Kyun
Byeon, Jeong-Sik
author_facet Lee, Jeong-Mi
Kim, Wan Soo
Kwak, Min Seob
Hwang, Sung-Wook
Yang, Dong-Hoon
Myung, Seung-Jae
Yang, Suk-Kyun
Byeon, Jeong-Sik
author_sort Lee, Jeong-Mi
collection PubMed
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.
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spelling pubmed-54300152017-05-18 Clinical outcome of endoscopic management in delayed postpolypectomy bleeding Lee, Jeong-Mi Kim, Wan Soo Kwak, Min Seob Hwang, Sung-Wook Yang, Dong-Hoon Myung, Seung-Jae Yang, Suk-Kyun Byeon, Jeong-Sik Intest Res Original Article 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. Korean Association for the Study of Intestinal Diseases 2017-04 2017-04-27 /pmc/articles/PMC5430015/ /pubmed/28522953 http://dx.doi.org/10.5217/ir.2017.15.2.221 Text en © Copyright 2017. Korean Association for the Study of Intestinal Diseases. http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Lee, Jeong-Mi
Kim, Wan Soo
Kwak, Min Seob
Hwang, Sung-Wook
Yang, Dong-Hoon
Myung, Seung-Jae
Yang, Suk-Kyun
Byeon, Jeong-Sik
Clinical outcome of endoscopic management in delayed postpolypectomy bleeding
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 Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430015/
https://www.ncbi.nlm.nih.gov/pubmed/28522953
http://dx.doi.org/10.5217/ir.2017.15.2.221
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