Risk of delayed bleeding after colorectal endoscopic submucosal dissection: the Limoges bleeding score.
Journal
Endoscopy
ISSN: 1438-8812
Titre abrégé: Endoscopy
Pays: Germany
ID NLM: 0215166
Informations de publication
Date de publication:
10 Oct 2023
10 Oct 2023
Historique:
medline:
11
10
2023
pubmed:
11
10
2023
entrez:
10
10
2023
Statut:
aheadofprint
Résumé
Clinically significant delayed bleeding (CSDB) is a frequent, and sometimes severe, adverse event after colorectal endoscopic submucosal dissection (ESD). We evaluated risk factors of CSDB after colorectal ESD. We analyzed a prospective registry of 940 colorectal ESDs performed from 2013 to 2022. The incidence of bleeding was evaluated up to 30 days. Risk factors for delayed bleeding were evaluated by multivariate logistic regression. A Korean scoring model was tested, and a new risk-scoring model was developed and internally validated. CSDB occurred in 75 patients (7.98%). The Korean score performed poorly in our cohort, with an ROC of 0.567. In the multivariate analysis, risk factors were age ≥ 75 years (OR, 1.60; 95% CI, 0.95,2.7; 1 point), use of antithrombotics (OR, 1.72; 95% CI, 1.01, 2.94; 1 point), rectal location (OR, 1.51; 95% CI, 0.92, 2.48; 1 point), size > 50mm (OR, 3.63; 95% CI, 2.02, 7.14; 3 points), and ASA score of III or IV (OR, 2.26; 95% CI, 1.32, 3.92; 2 points). The model showed a fair calibration and good discrimination, with an ROC curve of 0.751 (95% CI, 0.690-0.812). The score was used to define two groups of patients, those with low-medium (0 to 4 points) and high (5 to 8 points) risks of CSDB (respective bleeding rates 4.1% and 17.5%). A score based on five simple and meaningful variables is predictive of CSDB.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Clinically significant delayed bleeding (CSDB) is a frequent, and sometimes severe, adverse event after colorectal endoscopic submucosal dissection (ESD). We evaluated risk factors of CSDB after colorectal ESD.
METHODS
METHODS
We analyzed a prospective registry of 940 colorectal ESDs performed from 2013 to 2022. The incidence of bleeding was evaluated up to 30 days. Risk factors for delayed bleeding were evaluated by multivariate logistic regression. A Korean scoring model was tested, and a new risk-scoring model was developed and internally validated.
RESULTS
RESULTS
CSDB occurred in 75 patients (7.98%). The Korean score performed poorly in our cohort, with an ROC of 0.567. In the multivariate analysis, risk factors were age ≥ 75 years (OR, 1.60; 95% CI, 0.95,2.7; 1 point), use of antithrombotics (OR, 1.72; 95% CI, 1.01, 2.94; 1 point), rectal location (OR, 1.51; 95% CI, 0.92, 2.48; 1 point), size > 50mm (OR, 3.63; 95% CI, 2.02, 7.14; 3 points), and ASA score of III or IV (OR, 2.26; 95% CI, 1.32, 3.92; 2 points). The model showed a fair calibration and good discrimination, with an ROC curve of 0.751 (95% CI, 0.690-0.812). The score was used to define two groups of patients, those with low-medium (0 to 4 points) and high (5 to 8 points) risks of CSDB (respective bleeding rates 4.1% and 17.5%).
CONCLUSION
CONCLUSIONS
A score based on five simple and meaningful variables is predictive of CSDB.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Thieme. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare that they have no conflict of interest.