Factors associated with increased bleeding post-endoscopic mucosal resection

Objective: Our aim was to identify patient and procedure characteristics that correlate with increased likelihood of bleeding during and after endoscopic mucosal resection (EMR), and thus anticipate the need for preventative therapy. Methods: This was a retrospective, observational, descriptive study using a prospective EMR database, performed in a tertiary-care center. A total of 935 EMR of various locations within the gastrointestinal tract were collected. The main outcome measurement was early bleeding (occurring during the procedure) and delayed bleeding (occurring after the completion of the procedure and up to 30 days after). Results: Early bleeding occurred in 5.3% (50/935) of the procedures. In multivariate logistic regression analysis, esophageal EMR (OR 2.5, 95% CI 1.2-5, P=0.0009) and increase in lesion size (OR 1.24, 95% CI 1.1-1.5, P=0.003) were both associated with higher odds of early bleeding in EMR when controlling for age, gender and non-steroidal anti-inflammatory drugs (NSAIDs)/clopidogrel use. Delayed bleeding occurred after 3.1% (n=29) of the procedures. Of these, 86.2% (25/29) required hospital admission and endoscopic intervention to confirm and/or treat bleeding site. In multivariate logistic regression analysis, increased lesion size (OR 1.3, 95% CI 1.1-1.5, P=0.004) was associated with higher incidence of delayed bleeding post-EMR. Conclusions: In experienced hands bleeding during and after EMR appears to be uncommon. Larger lesions are at increased risk of early and delayed bleeding.