The risk factors for delayed bleeding after endoscopic resection of colorectal tumors: a meta-analysis

ABSTRACT

Introduction

The most common complication of post-colorectal endoscopic resection is delayed bleeding. The assessment of risk factors for delayed bleeding provides important and useful information in standard clinical operations. The risk factors have been previously reported; however, they remain inconsistent across different studies.

Areas covered

In this meta-analysis, the patient conditions, lesion-related factors, and operation-related factors were compared between delayed bleeding and no bleeding. PubMed, Cochrane, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Database were searched to identify eligible studies. Pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated along with heterogeneity.

Expert opinion

This study is the first meta-analysis to investigate risk factors for colorectal delayed bleeding. We found several risk factors contributing to this condition: colorectal tumors located in the proximal colon, a history of antithrombotic drug use, high-grade intraepithelial neoplasia or early cancer, piecemeal resection, intraoperative hemorrhage, no clip placement, and severe submucosal fibrosis. Despite our findings, we also conclude that more high-quality, large-scale clinical randomized controlled studies are needed due to limited retrospective studies at present. Future therapeutic colonoscopies should focus on precise diagnosis, treatment safety, and management during the perioperative period.

KEYWORDS:

• Endoscopic resection
• colorectal delayed bleeding
• colorectal tumor

Article highlights

• This is the first meta-analysis to investigate the risk factors for delayed bleeding after colorectal tumor resection.

• This article identified 22 relevant published studies (2012~2019) with a total of 9304 cases, the results must be more persuasive than those current small-sample or single-centered clinical studies.

• Based on the retrieved literature, we made a comprehensive assessment on the risk factors of delayed bleeding after colorectal endoscopic resection from the aspects of the patient’s condition, lesion itself, operative factors, etc.

• The study first indicated that less experienced operators were the risk factors for delayed bleeding after colorectal tumor resection.

• The study identified risk factors include colorectal tumors located in the proximal colon, a history of antithrombotic drug use, high-grade intraepithelial neoplasia or early cancer, piecemeal resection, intraoperative hemorrhage, no clip placement, severe submucosal fibrosis, and less operator experiences, and made detailed discussion for each risk factor.

• The study and its finding provide useful information for postoperative bleeding prevention and better clinical decisions leading to better patient outcome.

Acknowledgments

We sincerely thank the staff of Endoscopy Unit at the Fujian Provincial Hospital for their valuable assistance in the conduct of this study.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.