Delayed bleeding post-endoscopic ampullectomy for ampullary adenomas: Incidence, risk factors and management
Notice bibliographique
Résumé
Aims The duodenal tumors of major papilla account 10% of all peri-ampullary lesions [ 1 ]. Endoscopic ampullectomy became the treatment modality for selected cases. Despite the significantly lower rate of adverse events, bleeding occurs in up to 25% of patients [ 2 ]. The rate of bleeding may be even higher, depending on periampullary lesion size and type. Factors related to delayed bleeding are poorly understood. Our study aimed to determine predicting factors for delayed post-ampullectomy bleeding. Methods We conducted a single-center retrospective study including procedures performed between January 2011 and September 2023. All patients who underwent an endoscopic papillectomy were analyzed. The primary endpoint was the incidence of delayed bleeding, which was defined as a post-procedural bleeding that necessitated either a blood transfusion, ICU admission or re-intervention. Secondary outcomes included risk factors for delayed bleeding, time to delayed bleed, management, and other adverse events. Results 113 patients underwent endoscopic papillectomy [mean age 66.2±12.2 years; male gender 51 (45.1%)]. Mean lesion size was 27.0±14.3 mm and mean procedure duration was 62.8±35.6 minutes. There were 25 cases of delayed bleeding (22.1%). Of these, 20 (80%) required repeat endoscopic intervention, 6 (24%) required blood transfusions and 3 (12%) were managed conservatively. Delayed bleeding occurred at a median of 24 hours (IQR: 6-24; Figure 1). Only 4/25 (16%) of the delayed bleeds occurred after 24 hours. The average length of hospital was longer in those experiencing a delayed bleed (8.6±4.8 vs 4.8±2.4 days, P<0.001). Delayed bleeding was greater in those with hypertension (OR 2.6, 95% CI 1.0-6.6, P=0.045), an INR≥1.2 without blood thinners (OR 11.1, 95% CI 2.6-47.2, P=0.001) or histology revealing HGD/cancer as compared with LGD (OR 3.0, 95% CI 1.08-8.11, P=0.035). A multivariate logistic regression analysis revealed that only an INR≥1.2 predicted delayed bleeding, with an OR of 13.0 (95% CI 2.5-68.0, P=0.002), after adjusting for the presence of hypertension and histopathology. There were no other predictors, including age, gender, lesion size, background anti-platelet/coagulation use, or en bloc resection. By univariate Cox proportional hazards regression, time to delayed bleeding was 5.6 times faster in those with an INR≥1.2 (HR 5.6, 95% CI: 2.0-15.5, P=0.001; Figure 2). No other factors were related to time to delayed bleeding. Other adverse events included perforation (n=7, 6.3%) and pancreatitis (n=19, 16.8%). There were no deaths. Conclusions In conclusion, history of hypertension, elevated INR above 1.2 and histology revealing HGD/cancer are potentially related to delayed post-ampullectomy bleeding. Moreover, time to delayed bleeding is 5.6 times faster in those with an INR≥1.2 only. These factors might be taken into consideration when strategizing a reduction in post-ampullectomy bleeding. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».