Risk Factors for Delayed Bleeding After Endoscopic Resection for Large Colorectal Tumors

Objective: Endoscopic resection techniques for treating colorectal tumors have advanced re-cently so that large colorectal tumors can now be treated endoscopically, although somepatients experience delayed bleeding after endoscopic resection. Our aim was to clarify therisk factors for delayed bleeding after endoscopic resection for colorectal tumors 20 mm indiameter. Endoscopic submucosal dissection cases were excluded because of the low inci-dence of delayed bleeding after such procedures.Methods: This was a retrospective study using a prospectively completed database andpatient medical records at a single, national cancer institution. A total of 403 colorectal endo-scopic resections were performed on 375 consecutive patients. We analyzed the database andretrospectively assessed patient age, gender, hypertension and current use of anticoagulant(warfarin) or antiplatelet drugs (e.g. aspirin, ticlopidine) as well as tumor location, size, macro-scopic type, histopathological findings, resection method and whether or not placement ofprophylactic clips was performed during the endoscopic resection.Results: The overall rate of delayed bleeding was 4.2% (17/403) and the median intervalbetween endoscopic resection and the onset of delayed bleeding was 2 days (range, 1–14days). All delayed bleeding cases were successfully controlled byendoscopic hemostasis involv-ing clipping and/orelectrocoagulation without the need for surgical interventions or blood transfu-sions. Based on our univariate analysis, the delayed bleeding rate was significantly higher inboth males (P ¼ 0.04) and those patients without prophylactic clip placement (P ¼ 0.04).Conclusions: Our study results indicated that prophylactic clip placement may be an effectivemethod for preventing delayed bleeding afterendoscopic resection for large colorectal tumors.Key words: colorectal tumors – endoscopic resection – delayed bleeding