Risk of bleeding after esophagogastroduodenoscopy with mucosal resection in patients with cirrhosis

Esophagogastroduodenoscopy (EGD) with endoscopic mucosal resection (EMR) is commonly used for evaluating and managing gastrointestinal lesions. This study aimed to assess the 30-day risk of bleeding and other adverse outcomes following EGD-EMR in cirrhotic patients.

This retrospective cohort study utilized data from the US Collaborative Network to evaluate bleeding risk following EGD-EMR in cirrhotic patients. One-to-one propensity score matching was performed, with the primary outcome being bleeding within 30 days post-procedure.

Each cohort included 1,045 patients. Cirrhotic patients had higher risk of post-EGD-EMR bleeding (OR 1.65, 95% CI 1.21-2.25, P = 0.002) and were more likely to require a blood transfusion (OR 2.54, 95% CI 1.21-5.31, P = 0.011). However, ICU admissions (OR 1.33, P = 0.29) and endoscopic reinterventions (OR 1.31, P = 0.25) did not differ significantly. Patients with decompensated cirrhosis had a higher bleeding risk compared to controls (OR 1.62, 95% CI 1.05-2.51, P = 0.03), while those with compensated cirrhosis showed no increased risk (OR 1.16, P = 0.55).

This study found increased post-procedural bleeding in cirrhotic patients, particularly those with decompensated cirrhosis. Careful pre-procedural management of coagulopathy is crucial to minimize complications in these patients.