title: A Scoring System to Determine Risk of Delayed Bleeding After Endoscopic Mucosal Resection of Large Colorectal Lesions.
abstract: After endoscopic mucosal resection (EMR) of colorectal lesions, delayed bleeding is the most common serious complication, but there are no guidelines for its prevention. We aimed to identify risk factors associated with delayed bleeding that required medical attention after discharge until day 15 and develop a scoring system to identify patients at risk.
  
  
  
  We performed a prospective study of 1214 consecutive patients with nonpedunculated colorectal lesions 20 mm or larger treated by EMR (n = 1255) at 23 hospitals in Spain, from February 2013 through February 2015. Patients were examined 15 days after the procedure, and medical data were collected. We used the data to create a delayed bleeding scoring system, and assigned a weight to each risk factor based on the β parameter from multivariate logistic regression analysis. Patients were classified as being at low, average, or high risk for delayed bleeding.
  
  
  
  Delayed bleeding occurred in 46 cases (3.7%, 95% confidence interval, 2.7%-4.9%). In multivariate analysis, factors associated with delayed bleeding included age ≥75 years (odds ratio [OR], 2.36; P < .01), American Society of Anesthesiologist classification scores of III or IV (OR, 1.90; P ≤ .05), aspirin use during EMR (OR, 3.16; P < .05), right-sided lesions (OR, 4.86; P < .01), lesion size ≥40 mm (OR, 1.91; P ≤ .05), and a mucosal gap not closed by hemoclips (OR, 3.63; P ≤ .01). We developed a risk scoring system based on these 6 variables that assigned patients to the low-risk (score, 0-3), average-risk (score, 4-7), or high-risk (score, 8-10) categories with a receiver operating characteristic curve of 0.77 (95% confidence interval, 0.70-0.83). In these groups, the probabilities of delayed bleeding were 0.6%, 5.5%, and 40%, respectively.
  
  
  
  The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.
authors.affiliation: Complejo Hospitalario de Navarra, Pamplona, Spain. Electronic address: edualbeniz@hotmail.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Albéniz
authors.affiliation: Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Fraile
authors.affiliation: NavarraBiomed-Fundación Miguel Servet and Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Pamplona, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Ibáñez
authors.affiliation: Hospital Juan Canalejo, La Coruña, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso-Aguirre
authors.affiliation: Complejo Hospitalario de Vigo, Vigo, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Martínez-Ares
authors.affiliation: Complejo Hospitalario de Ourense, Ourense, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Soto
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
authors.forename: Carla Jerusalén
authors.initials: CJ
authors.lastname: Gargallo
authors.affiliation: Hospital Universitario HM Montepríncipe, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Ramos Zabala
authors.affiliation: Hospital del Mar, Barcelona, Spain.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Álvarez
authors.affiliation: Hospital General de Ciudad Real, Ciudad Real, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Rodríguez-Sánchez
authors.affiliation: Hospital Universitario Donostia, Donostia-San Sebastián, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Múgica
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Nogales
authors.affiliation: Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Herreros de Tejada
authors.affiliation: Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Redondo
authors.affiliation: Hospital Juan Canalejo, La Coruña, Spain.
authors.forename: Noel
authors.initials: N
authors.lastname: Pin
authors.affiliation: Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: León-Brito
authors.affiliation: Hospital Juan Canalejo, La Coruña, Spain.
authors.forename: Remedios
authors.initials: R
authors.lastname: Pardeiro
authors.affiliation: Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: López-Roses
authors.affiliation: Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Téllez
authors.affiliation: Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Jiménez
authors.affiliation: Centro Andaluz de Gastroenterología Integral, Sevilla, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Martínez-Alcalá
authors.affiliation: Hospital Moisès Broggi, Sant Joan Despí, Spain.
authors.forename: Orlando
authors.initials: O
authors.lastname: García
authors.affiliation: Hospital de Valdecilla, Santander, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: de la Peña
authors.affiliation: Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ono
authors.affiliation: Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alberca de Las Parras
authors.affiliation: Hospital Clinic, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Pellisé
authors.affiliation: Hospital Clinic, Barcelona, Spain.
authors.forename: Liseth
authors.initials: L
authors.lastname: Rivero
authors.affiliation: Hospital General de Catalunya, Barcelona, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Saperas
authors.affiliation: Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Pérez-Roldán
authors.affiliation: Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pueyo Royo
authors.affiliation: Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Eguaras Ros
authors.affiliation: Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Zúñiga Ripa
authors.affiliation: Hospital de la Santa Creu y Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Concepción-Martín
authors.affiliation: Hospital de la Santa Creu y Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Huelin-Álvarez
authors.affiliation: Hospital de la Santa Creu y Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Colán-Hernández
authors.affiliation: Complejo Hospitalario de Ourense, Ourense, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Cubiella
authors.affiliation: Complejo Hospitalario de Ourense, Ourense, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Remedios
authors.affiliation: Hospital del Mar, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bessa I Caserras
authors.affiliation: Hospital General de Ciudad Real, Ciudad Real, Spain.
authors.forename: Bartolomé
authors.initials: B
authors.lastname: López-Viedma
authors.affiliation: Hospital Universitario Donostia, Donostia-San Sebastián, Spain.
authors.forename: Julyssa
authors.initials: J
authors.lastname: Cobian
authors.affiliation: Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: González-Haba
authors.affiliation: Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Santiago
authors.affiliation: Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Juan Gabriel
authors.initials: JG
authors.lastname: Martínez-Cara
authors.affiliation: Hospital Juan Canalejo, La Coruña, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Valdivielso
authors.affiliation: Hospital de la Santa Creu y Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner-Argente
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D013030:Spain; D055815:Young Adult
keywords: ASA; Colon Cancer; Mucosectomy; Prognostic Factor