PMID- 31839962
OWN - NLM
STAT- MEDLINE
DCOM- 20200629
LR  - 20200629
IS  - 2050-6414 (Electronic)
IS  - 2050-6406 (Print)
IS  - 2050-6406 (Linking)
VI  - 7
IP  - 10
DP  - 2019 Dec
TI  - Intra-procedural and delayed bleeding after resection of large colorectal 
      lesions: The SCALP study.
PG  - 1361-1372
LID - 10.1177/2050640619874176 [doi]
AB  - BACKGROUND AND AIM: The safety of endoscopic resection of large colorectal 
      lesions (LCLs) (>/=20 mm) is clinically relevant. The aim of the present study was 
      to assess the rate of post-resection adverse events (AEs) in a real-life setting. 
      PATIENTS AND METHODS: In a prospective, multicentre, observational study, data 
      from consecutive resections of LCLs over a 6-month period were collected in 24 
      centres. Patients were followed up at 15 days from resection for AEs. The primary 
      endpoint was intra-procedural bleeding according to lesion morphology. Secondary 
      endpoints were delayed bleeding and perforation. Patient and polyp 
      characteristics, and polypectomy techniques were analysed with respect to the 
      bleeding events. RESULTS: In total, 1504 patients (female/male: 633/871, mean 
      age, 66.1) with 1648 LCLs (29.1% pedunculated and 70.9% non-pedunculated lesions) 
      were included. Overall, 168 (11.2%) patients had post-resection bleeding (8.5 and 
      2.0% immediate and delayed, respectively), while 15 (1.0%) cases of perforation 
      occurred. Independent predictors of immediate bleeding for pedunculated lesions 
      were bleeding prophylaxis (odds ratio (OR) 0.28, 95% confidence interval (CI) 
      0.13-0.62), simple polypectomy (versus endoscopic mucosal resection, OR 0.38, 95% 
      CI 0.17-0.88) and inpatient setting (OR 2.21, 95% CI 1.07-5.08), while bleeding 
      prophylaxis (OR 0.37, 95% CI 0.30-0.98), academic setting (OR 0.27, 95% CI 
      0.12-0.54) and size (OR 1.03, 95% CI 1.00-1.05) were predictors for those 
      non-pedunculated. Indication for colonoscopy (screening versus diagnostic (OR 
      0.33, 95% CI 0.12-0.86)), antithrombotic therapy (OR 3.12, 95% CI 1.54-6.39) and 
      size (OR 2.34, 95% CI 1.12-4.87) independently predicted delayed bleeding. 
      CONCLUSIONS: A low rate of post-resection AEs was observed in a real-life 
      setting, reassuring as to the safety of endoscopic resection of >/=2 cm colorectal 
      lesions. Bleeding prophylaxis reduced the intra-procedural bleeding risk, while 
      antithrombotic therapy increased delayed bleeding.CLINICALTRIAL: (NCT02694120).
CI  - (c) Author(s) 2019.
FAU - Amato, Arnaldo
AU  - Amato A
AUID- ORCID: 0000-0002-4397-4142
AD  - Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, 
      Italy.
FAU - Radaelli, Franco
AU  - Radaelli F
AD  - Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, 
      Italy.
FAU - Correale, Loredana
AU  - Correale L
AD  - Department of Gastroenterology, Nuovo Regina Margherita Hospital, Roma, Italy.
FAU - Di Giulio, Emilio
AU  - Di Giulio E
AD  - Endoscopy Unit, S.Andrea Hospital, Roma, Italy.
FAU - Buda, Andrea
AU  - Buda A
AD  - Digestive Endoscopy Unit, S.Maria del Prato Hospital, Feltre, Italy.
FAU - Cennamo, Vincenzo
AU  - Cennamo V
AD  - Unit of Gastroenterology and Digestive Endoscopy, Maggiore Hospital, Bologna, 
      Italy.
FAU - Fuccio, Lorenzo
AU  - Fuccio L
AD  - Gastroenterology Unit, Department of Medical and Surgical Sciences, Policlinico 
      S. Orsola, Bologna, Italy.
FAU - Devani, Massimo
AU  - Devani M
AD  - Department of Gastroenterology, Rho Hospital, Rho, Italy.
FAU - Tarantino, Ottaviano
AU  - Tarantino O
AD  - Gastroenterology Unit, S.Giuseppe Hospital, Empoli, Italy.
FAU - Fiori, Giancarla
AU  - Fiori G
AD  - Digestive Endoscopy Unit, European Institute of Oncology, Milano, Italy.
FAU - De Nucci, Germana
AU  - De Nucci G
AD  - Department of Gastroenterology, Salvini Hospital, Garbagnate, Italy.
FAU - De Bellis, Mario
AU  - De Bellis M
AD  - Gastroenterology and Endoscopy Unit, Department of Abdominal Oncology, Istituto 
      Nazionale Tumore, Napoli, Italy.
FAU - Hassan, Cesare
AU  - Hassan C
AUID- ORCID: 0000-0001-7167-1459
AD  - Department of Gastroenterology, Nuovo Regina Margherita Hospital, Roma, Italy.
FAU - Repici, Alessandro
AU  - Repici A
AD  - Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research 
      Hospital, Milano, Italy.
CN  - Bowell Group
LA  - eng
SI  - ClinicalTrials.gov/NCT02694120
PT  - Journal Article
PT  - Multicenter Study
DEP - 20190923
PL  - England
TA  - United European Gastroenterol J
JT  - United European gastroenterology journal
JID - 101606807
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Child, Preschool
MH  - Colectomy/*adverse effects/methods
MH  - Colonic Polyps
MH  - Colonoscopy/adverse effects/methods
MH  - Colorectal Neoplasms/*complications/surgery
MH  - Female
MH  - Humans
MH  - Intestinal Perforation/etiology
MH  - Intraoperative Complications/diagnosis/*epidemiology/*etiology
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Postoperative Hemorrhage/diagnosis/*epidemiology/*etiology
MH  - Prospective Studies
MH  - Time Factors
MH  - Young Adult
PMC - PMC6893999
OTO - NOTNLM
OT  - Large colorectal lesions
OT  - endoscopic resection
OT  - polypectomy
OT  - post-resection bleeding
EDAT- 2019/12/17 06:00
MHDA- 2020/07/01 06:00
PMCR- 2019/12/01
CRDT- 2019/12/17 06:00
PHST- 2019/06/12 00:00 [received]
PHST- 2019/08/12 00:00 [accepted]
PHST- 2019/12/17 06:00 [entrez]
PHST- 2019/12/17 06:00 [pubmed]
PHST- 2020/07/01 06:00 [medline]
PHST- 2019/12/01 00:00 [pmc-release]
AID - 10.1177_2050640619874176 [pii]
AID - 10.1177/2050640619874176 [doi]
PST - ppublish
SO  - United European Gastroenterol J. 2019 Dec;7(10):1361-1372. doi: 
      10.1177/2050640619874176. Epub 2019 Sep 23.