30 - Risk of Bleeding After Colorectal Endoscopic Mucosal Resection in Patients With Cirrhosis: A Propensity-Matched Analysis of the US Collaborative Network

Award: ACG Outstanding Research Award in the Colon Category (Trainee)

Azizullah Beran, MD¹, Khaled Elfert, MD², Mouhand F.H. Mohamed, MD, MSc³, Douglas Rex, MD¹, Indira Bhavsar-Burke, MD, MHPE⁴, John Guardiola, MD^1
1Indiana University School of Medicine, Indianapolis, IN; ²West Virginia University, Morgantown, WV; ³Mayo Clinic, Rochester, MN; ⁴University of Texas Southwestern Medical Center, Dallas, TX

Introduction: Endoscopic mucosal resection (EMR) is the preferred treatment for large nonpedunculated colorectal polyps. Gastrointestinal (GI) bleeding is the most frequent major adverse event after colorectal EMR. Patients with cirrhosis may bleed because of coagulation factor synthesis disruption, thrombocytopenia, or portal hypertension.Risk of bleeding following colorectal EMR in patients with cirrhosis has not been evaluated. We conducted a retrospective U.S.-based, propensity-matched cohort study to assess risk of post-colorectal EMR bleeding in patients with cirrhosis.

Methods: We analyzed the U.S. Collaborative Network in the TriNetX platform through 4/6/2024 for patients with cirrhosis who underwent colorectal EMR. One-to-one propensity score matching was performed. The risk of each outcome was calculated and expressed as odds ratio (OR) with a 95% confidence interval (CI). Two-sided p-value < 0.05 was considered statistically significant. Primary outcome was risk of lower GI bleeding within 30 days of EMR. Secondary outcomes were endoscopic reintervention for control of bleeding, emergency department (ED) visits, inpatient admissions, and intensive care unit (ICU) admissions.

Results: After one-to-one propensity score matching for age, race, ethnicity, sex, hypertension, diabetes mellitus, chronic kidney disease, thrombocytopenia, use of anticoagulants/antiplatelets, there were 4,274 subjects (2,137 in the cirrhosis cohort and 2,137 in the matched control cohort) who underwent colorectal EMR. Patients with cirrhosis had an increased risk of post-EMR bleeding compared with matched control subjects (OR 1.38, 95% CI 1.04-1.83, p=0.02) along with increased blood transfusions (OR 2.09, 95% CI 1.10-3.96, p=0.02), ED visits (OR 1.64, 95% CI 1.27-2.11, p< 0.001) and inpatient admissions (OR 1.44, 95% CI 1.14-1.80, p=0.002), but no differences in endoscopic reinterventions for control of bleeding (OR 0.80, 95% CI 0.47-1.37, p=0.42) and ICU admission (OR 1.30, 95% CI 0.79-2.16, p=0.31). (Table)

Discussion: Patients with cirrhosis have a higher risk of post-EMR bleeding and require more blood transfusions compared to matched controls, but absolute risk remains low. The rates of endoscopic reintervention for bleeding and ICU admissions are similar between the groups. Optimizing patients with cirrhosis prior to colorectal EMR and monitoring for post-procedure bleeding remains important. Conservative, supportive management of bleeding in cirrhotic patients may be as effective as in non-cirrhotic patients.



Disclosures:


Azizullah Beran, MD¹, Khaled Elfert, MD², Mouhand F.H. Mohamed, MD, MSc³, Douglas Rex, MD¹, Indira Bhavsar-Burke, MD, MHPE⁴, John Guardiola, MD¹, 30, Risk of Bleeding After Colorectal Endoscopic Mucosal Resection in Patients With Cirrhosis: A Propensity-Matched Analysis of the US Collaborative Network, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.