IDDF2023-ABS-0312 A risk-scoring system for predicting delayed bleeding after colorectal ESD

Background

Delayed bleeding is a crucial adverse event after colorectal endoscopic submucosal dissection (ESD). While there is limited knowledge regarding the accurate prediction of delayed bleeding or systematic evaluation. Therefore, our study intended to develop a risk-scoring system for delayed bleeding after colorectal ESD.

Methods

We randomly divided (3:1) the patients who underwent colorectal ESD between January 2008 to January 2021 into the derivation and validation set. Univariate and multivariate analysis were applied to choose independent risk factors associated with delayed bleeding in the derivation set. Subsequently, we developed a risk-scoring system and the scoring system, which was verified furtherly in a validation set.

Results

In the derivation set, the multivariate analysis showed that the lesion located in the rectum (odds ratio [OR] 4.621; 95% confidence interval (CI) 1.296-16.470; P=0.018), lesion size ≥20 mm (OR 4.077; 95%CI 1.474-11.275; P=0.007), using Argon plasma coagulation (APC) for wound management (OR 2.502; 95%CI 1.016-6.161; P=0.046), and partial closure of ulcer with clips (OR 3.465; 95%CI 1.051-11.424; P=0.041) were independent risk factors for delayed bleeding after colorectal ESD. In the derivation set, the area under the receiver operator characteristic curve (AUC) of the risk-scoring system is 0.757 (95%CI 0.657-0.857, P<0.001). When performing risk stratification, the incidence of delayed bleeding between the low-risk group (score≤2) and high-risk group (score >2) were 1.2% and 7.1%, respectively (P < 0.001) (IDDF2023-ABS-0312 Figure 1. Receiver operating curve ROC of (A) The derivation set (B) The validation set for the risk scoring system).

Conclusions

The risk-scoring system developed in this study is uncomplicated and practical, which provides a reference tool to guide the decision-making process before undertaking an endoscopic submucosal dissection.