Risk Factors for Delayed Bleeding and Its Impact on Long-Term Efficacy After Endoscopic Sclerotherapy for Internal...

Area of Science:

• Gastroenterology
• Colorectal Surgery

Background:

• Endoscopic injection sclerotherapy (EIS) with lauromacrogol is used for internal hemorrhoids (IHs).
• Delayed hemorrhage is a potential complication following EIS.

Purpose of the Study:

• To investigate the incidence, timing, risk factors, and prognosis of delayed hemorrhage after EIS for IHs.
• To evaluate the long-term efficacy of EIS in patients who experience delayed bleeding.

Main Methods:

• Retrospective analysis of 252 patients undergoing EIS for IHs using an inverted colonoscope without transparent caps.
• Delayed hemorrhage defined as bleeding between 24 hours and 1 month postoperatively.
• Multivariate logistic regression used to identify independent risk factors for delayed bleeding.

Main Results:

• Delayed bleeding occurred in 17.5% of patients, typically mild (<20 mL) and self-limiting, with a median onset of 2 days.
• Independent risk factors included low albumin (<40 g/L), high triglycerides (>1.7 mmol/L), severe constipation (Wexner Score ≥15), and >4 injection sites.
• One case of massive bleeding (500 mL) occurred on postoperative Day 17, potentially due to deep or high injection.
• Long-term treatment effectiveness (2-year follow-up) did not differ significantly between patients with and without delayed bleeding (p = 0.622).

Conclusions:

• Delayed bleeding is a frequent but generally manageable complication of EIS for IHs.
• Identifying and managing risk factors like hypertriglyceridaemia, hypoproteinaemia, and constipation is crucial.
• Caution is advised regarding injection depth and position to prevent severe bleeding.
• Adherence to procedural guidelines, potentially including transparent caps or forward-view endoscopy, is recommended.