Abstract:

Objective

To summarize the clinical characteristics of bleeding in elderly patients undergoing colorectal endoscopic submucosal dissection （ESD） and identify the risk factors associated with bleeding.

Methods

A retrospective analysis was conducted on elderly patients who underwent colorectal ESD at Beijing Friendship Hospital， Capital Medical University from January 2017 to October 2020. Patient history， characteristics of colorectal lesions， procedural details， and patient outcomes were analyzed.

Results

A total of 278 patients were included in the study. Among them， 218 patients （78.4%） were aged 60-74 years， 60 （21.6%） were aged 75～89 years， and none were aged 90 years or older， with an average age of（68.62±6.822） years. Lesion diameters were ＜2 cm in 117 cases， 2～＜5 cm in 138， and ≥5 cm in 23，with an average lesion diameter of （2.323±1.356） cm. Pathological findings included 150 cases of adenoma，23 cases of high-grade intraepithelial neoplasia， 65 cases of malignant lesions， 18 cases of neuroendocrine tumors， 3 cases of benign lesions， and 19 cases of inflammation. Intraoperative bleeding occurred in 22 cases，including 2 cases of major bleeding， while postoperative bleeding occurred in 27 cases， including 6 cases of major bleeding. Multivariate analysis revealed that the occurrence of ESD bleeding was mainly associated with pathological type and lesion diameter.

Conclusion

The incidence of bleeding is higher in patients with malignant lesions， and the larger the lesion diameter， the higher the incidence of bleeding. Malignant lesions and lesion diameters ≥2 cm are independent risk factors for ESD bleeding. For lesions with a large diameter or malignant lesions undergoing colorectal ESD， attention should be paid to preventing bleeding.

Key words: Elderly, Endoscopic submucosal dissection, Superficial colorectal mass, Bleeding, Risk factors