医学
剪裁(形态学)
倾向得分匹配
外科
息肉切除术
结肠镜检查
回顾性队列研究
阿司匹林
优势比
内科学
结直肠癌
癌症
哲学
语言学
作者
Louis H.S. Lau,Wei Jiang,Cosmos L.T. Guo,Rashid N. Lui,Raymond S.Y. Tang,Francis K.L. Chan
标识
DOI:10.1016/j.gie.2022.09.024
摘要
Abstract
Background and Aims
Anti-thrombotics use is a significant risk factor of post-polypectomy bleeding (PPB). Evidence of prophylactic clipping is only available for proximal and large colonic lesions in general population. Dedicated studies to examine the benefit of prophylactic clipping in patients on aspirin remain scarce. Methods
A propensity-score weighted retrospective cohort study was performed in a tertiary referral center from January 2018 to September 2021. Patients who received aspirin and underwent colonoscopic polypectomy, endoscopic mucosal resection or endoscopic submucosal dissection were included. Data on baseline demographics, medications and endoscopic factors (polyp number, size, location, morphology, resection method and prophylactic clipping) were captured. Propensity-score weighting models were developed between prophylactic clipping and no clipping groups. The primary outcome was delayed PPB within 30 days, with a composite endpoint consisting of repeated colonoscopy for hemostasis, requirement of blood transfusion or hemoglobin drop of greater than 2g/dL. Results
Total 1,373 patients with 3,952 polyps were included. Baseline characteristics were balanced between two groups. In the multivariate analysis, the largest polyp size was a significant risk factor for PPB (odds ratio (OR) 1.07, 95%CI 1.02-1.11, p=0.002). Prophylactic clipping was not associated with a reduced risk of PPB (OR 1.34, 95%CI 0.83-2.18, p=0.240) and did not show any risk reduction in subgroups with different polyp sizes, locations and endoscopic resection techniques. Conclusion
Prophylactic clipping was not associated with a lower risk of PPB in aspirin users after endoscopic resection of colorectal polyps. Aspirin use should not be regarded as the only factor for the routine use of prophylactic clips.
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