Indication of emergency colonoscopy after colorectal endoscopic submucosal dissection: A proposal of hematochezia scale.

Hematochezia is a major adverse event associated with colorectal endoscopic submucosal dissection (ESD). This study aimed to distinguish between hematochezia that required endoscopic hemostasis and hematochezia that required no hemostasis. This retrospective study included consecutive patients who underwent ESD for colorectal tumors at the Osaka International Cancer Institute between September 2017 and August 2020. The exclusion criteria were as follows: patients with coexisting advanced colorectal cancers or inflammatory bowel diseases, patients who received incomplete ESD or emergency surgery, or patients who underwent ESD for multiple lesions. We evaluated whether the patients had hematochezia and underwent emergency colonoscopy and hemostasis during hospitalization. The degree of hematochezia in the saved photographs was assessed using the hematochezia scale and classified as mild, moderate, or severe. Blood pressure, heart rate, time from ESD to first hematochezia, and total number of hematochezia episodes were also evaluated. Among the 437 patients who underwent ESD, 44 were excluded, and 393 patients were evaluated. Hematochezia was observed in 100 patients (25%). Emergency colonoscopy was performed in 12 patients (3%), and hemostasis was required in six patients (2%). For patients with hematochezia, only mild hematochezia and hematochezia that developed ≤ 48 h after ESD were significantly associated with no intervention for hemostasis. The positive predictive value for no intervention for hemostasis was 100% (93-100%) for mild hematochezia and 98% (93-100%) for hematochezia ≤ 48 h. Mild hematochezia and hematochezia ≤ 48 h were negative predictors of hemostasis, in which emergency colonoscopy may be avoided. © 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Citation

Yasuhiro Tani, Takashi Kanesaka, Yoji Takeuchi, Yuki Okubo, Yushi Kawakami, Hirohisa Sakurai, Takahiko Nakamura, Katsunori Matsueda, Muneaki Miyake, Satoki Shichijo, Akira Maekawa, Sachiko Yamamoto, Koji Higashino, Noriya Uedo, Tomoki Michida, Ryu Ishihara. Indication of emergency colonoscopy after colorectal endoscopic submucosal dissection: A proposal of hematochezia scale. Journal of gastroenterology and hepatology. 2022 Jun 23

PMID: 35735159

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