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A risk-scoring model for the prediction of delayed bleeding after colorectal endoscopic submucosal dissection
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2018-12-03 , DOI: 10.1016/j.gie.2018.11.029
Myeongsook Seo , Eun Mi Song , Jin Woong Cho , Young Jae Lee , Bo-In Lee , Jin Su Kim , Seong Woo Jeon , Hyun Joo Jang , Dong-Hoon Yang , Byong Duk Ye , Jeong-Sik Byeon

Background and Aims

Delayed bleeding is an important adverse event after colorectal endoscopic submucosal dissection (ESD). We aimed to investigate the incidence and risk factors of delayed bleeding after colorectal ESD and to develop a risk-scoring model for predicting delayed bleeding.

Methods

This retrospective study was performed at 5 centers. The derivation and validation cohorts comprised 1189 patients from 1 center and 415 patients from the other 4 centers. We investigated the incidence and risk factors of delayed bleeding. Then, we developed a risk-scoring model for predicting delayed bleeding by using the data of the derivation cohort. We validated the scoring system in the validation cohort.

Results

Delayed bleeding occurred in 34 patients (2.9%) in the derivation cohort. In multivariate analysis, the risk factors of delayed bleeding were tumor location in the rectosigmoid colon (odds ratio [OR], 6.49; 95% confidence interval [CI], 1.96-21.42; P = .002), large tumor (≥30 mm) (OR, 2.10; 95% CI, 1.01-4.40; P = .048), and use of antiplatelet agents except for aspirin alone (OR, 4.04; 95% CI, 1.44-11.30; P = .008). These 3 factors were incorporated into a risk-scoring model for prediction of delayed bleeding. As the score based on this system increased, the incidence of delayed bleeding increased in the validation cohort.

Conclusion

The risk-scoring model incorporating tumor location, tumor size, and use of antiplatelet agents can quantitatively predict the risk of delayed bleeding after colorectal ESD.



中文翻译:

大肠内镜黏膜下剥离术后延迟出血的风险评估模型

背景和目标

延迟出血是结直肠内镜黏膜下剥离(ESD)后的重要不良事件。我们旨在研究结直肠ESD术后延迟出血的发生率和危险因素,并建立预测延迟出血的风险评分模型。

方法

这项回顾性研究在5个中心进行。推导和验证队列包括来自一个中心的1189例患者和来自其他4个中心的415例患者。我们调查了延迟出血的发生率和危险因素。然后,我们使用派生队列的数据开发了一种风险评分模型,用于预测延迟出血。我们在验证队列中验证了评分系统。

结果

在衍生队列中有34例患者(2.9%)发生了延迟出血。在多变量分析中,延迟出血的危险因素是直肠乙状结肠肿瘤位置(比值比[OR]为6.49; 95%置信区间[CI]为1.96-21.42;P = .002),大肿瘤(≥30 mm) )(OR,2.10; 95%CI,1.01-4.40;P  = .048),以及使用抗血小板药,但单独使用阿司匹林除外(OR,4.04; 95%CI,1.44-11.30;P  = .008 )。将这3个因素整合到风险评分模型中,以预测延迟出血。随着基于该系统的评分的增加,验证队列中延迟出血的发生率增加。

结论

结合肿瘤位置,肿瘤大小和使用抗血小板药的风险评估模型可以定量预测结直肠ESD后延迟出血的风险。

更新日期:2018-12-03
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