Risk of delayed bleeding after colorectal endoscopic submucosal dissection: the Limoges Bleeding Score

 

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Abstract

Background Clinically significant delayed bleeding (CSDB) is a frequent, and sometimes severe, adverse event after colorectal endoscopic submucosal dissection (ESD). We evaluated risk factors of CSDB after colorectal ESD.

Methods We analyzed a prospective registry of 940 colorectal ESDs performed from 2013 to 2022. The incidence of bleeding was evaluated up to 30 days. Risk factors for delayed bleeding were evaluated by multivariate logistic regression. A Korean scoring model was tested, and a new risk-scoring model was developed and internally validated.

Results CSDB occurred in 75 patients (8.0%). The Korean score performed poorly in our cohort, with a receiver operating characteristic (ROC) curve of 0.567. In the multivariate analysis, risk factors were age ≥75 years (odds ratio [OR] 1.63; 95%CI 0.97–2.73; 1 point), use of antithrombotics (OR 1.72; 95%CI 1.01–2.94; 1 point), rectal location (OR 1.51; 95%CI 0.92–2.48; 1 point), size >50 mm (OR 3.67; 95%CI 2.02–7.14; 3 points), and American Society of Anesthesiologists (ASA) score of III or IV (OR 2.26; 95%CI 1.32–3.92; 2 points). The model showed fair calibration and good discrimination, with an area under the ROC curve of 0.751 (95%CI 0.690–0.812). The score was used to define two groups of patients, those with low–medium risk (0 to 4 points) and high risk (5 to 8 points) for CSDB (respective bleeding rates 4.1% and 17.5%).

Conclusion A score based on five simple and meaningful variables was predictive of CSDB.

Publication History

Received: 30 March 2023

Accepted after revision: 10 October 2023

Accepted Manuscript online:
10 October 2023

Article published online:
20 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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