Old age, antiplatelet use, right colon polyp predict post-EMR bleeding in cirrhotics

Endoscopic mucosal resection (EMR) in patients with cirrhosis delivers an acceptable bleeding risk, as indicated in a recent study. Independent risk factors for bleeding included age >65 years, right colon polyp, polyp size >15 mm, and use of antiplatelets within 5 days.

“There is limited data regarding the safety of EMR in the cirrhotic population,” the authors said. To address this gap, they sought to evaluate the safety of colonoscopic EMR in cirrhosis in this retrospective review.

Cirrhotic patients who underwent colonic EMR at eight Cleveland Clinic Centers between 1 January 2006 and 31 December 2018 were included. The authors collected patient data, including polyp details and complications occurring within 30 days of the procedure. Finally, they conducted univariable and multivariable regression analyses to find risk factors for post-EMR bleeding.

Overall, 238 patients who underwent EMT (mean age 61.9±8.6 years, 60.9 percent males) were retrospectively reviewed. Rates of immediate and delayed bleeding and postpolypectomy syndrome were 9.2 percent, 5.8 percent, and 1.3 percent, respectively.

The following factors were significantly associated with the risk for postpolypectomy bleeding: increased age (p=0.001), procedure duration >37 minutes (p=0.001), antiplatelet use within 5 days (p=0.023), and lesion diameter >15 mm (p=0.004).

In multivariable analysis, age >65 years (odds ratio [OR], 2.14; p=0.044), antiplatelet use within 5 days (OR, 2.42; p=0.047), right colon polyp (OR, 3.51; p=0.001), and lesion diameter >15 mm (OR, 3.22; p=0.003) independently predicted procedure-related bleeding.