Patients with cirrhosis have higher risk for bleeding after endoscopic mucosal resection
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Key takeaways:
- Patients with cirrhosis had a higher risk for post-EMR bleeding compared with controls.
- There was no difference between groups in reinterventions for hemostasis, blood transfusions or ICU admissions.
PHILADELPHIA — Patients with cirrhosis had an increased risk for bleeding within 30 days of colorectal endoscopic mucosal resection compared with controls, although the need for reintervention or ICU admission was similar between groups.
“[Endoscopic mucosal resection (EMR)] is the preferred treatment for benign, large, nonpedunculated colorectal polyps of 20 mm or more in size, and GI bleeding is the most frequent major adverse event after colorectal EMR,” Azizullah Beran, MD, a third-year GI fellow at Indiana University School of Medicine, told attendees at the ACG Annual Scientific Meeting. “Patients with cirrhosis are more prone to bleeding after invasive procedures, including elective and emergent surgeries.”
He added, “Bleeding risk after colorectal EMR in patients with cirrhosis is not well-studied.”
In a retrospective, propensity-matched cohort study, Beran and colleagues investigated this risk among patients with and without cirrhosis using the U.S. Collaborative Network in the TriNetX platform. They identified patients who underwent colorectal EMR through July 2024 and divided them into cirrhosis and control cohorts (n = 2,218 each), matching them 1:1 for age, race, ethnicity, sex, hypertension, diabetes mellitus, chronic kidney disease, thrombocytopenia and use of anticoagulants or antiplatelets. The researchers also identified a subgroup of patients with decompensated cirrhosis, which was matched to a control group.
The primary outcome was risk for GI bleeding within 30 days of EMR, while secondary outcomes included endoscopic reintervention to control bleeding, blood transfusion and ICU admission.
According to study results, patients with cirrhosis had higher rates of bleeding after EMR compared with controls (5.3% vs. 3.9%; OR = 1.38; 95% CI, 1.04-1.84), as did those with decompensated cirrhosis (8.9% vs. 5.3%; OR = 1.73; 95% CI, 1.06-2.84).
However, there was no difference between cirrhosis and control groups in the need for endoscopic reintervention (0.9% vs. 1.4%; OR = 0.67; 95% CI, 0.39-1.18), blood transfusion (1.3% vs. 0.7%; OR = 1.76; 95% CI, 0.95-3.26) or ICU admission (1.4% vs. 1.4%; OR = 1.04; 95% CI, 0.62-1.71).
“Cirrhosis patients had a higher rate of post-EMR bleeding compared to controls, but endoscopic intervention for homeostasis was similar,” Beran said. “Optimizing patients with cirrhosis before colorectal EMR and monitoring for post-procedural bleeding remains important.”
He continued: “A conservative, supportive approach to managing bleeding in patients with cirrhosis may be as effective as in those without cirrhosis. Further prospective studies are needed to confirm these findings, explore the benefits of prophylactic lesion closure beyond the current guidelines and assess the potential use of cold resection in this population.”
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Beran A, et al. Risk of bleeding after colorectal endoscopic mucosal resection in patients with cirrhosis: A propensity-matched analysis of the US collaborative network. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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