Page 76 - 北京京煤集团总医院第十一届·2023学术年会论文集

北京京煤集团总医院 第十一届·2023 学术年会论文集

of atherosclerosis and the elasticity of blood vessels are further weakened. Furthermore, blood
pressure fluctuates greatly, and hemodynamics are unstable, which easily causes blood vessel

rupture and bleeding at the cutting site [27] . Diabetes is known to be a risk factor for ischemic disease,
but it remains unclear whether it is a risk factor for bleeding [28] . The current study found that
diabetes increases the risk of DPPB, but the underlying mechanism of this relationship has yet to be
fully elucidated. This study found that oral antithrombotic drugs and aspirin could increase the

incidence of DPPB, which was consistent with the conclusions of Bum Su Choung et al .[19, 21] and
Xianyi Lin et al. [13, 18, 21] .
Regarding polyp-related factors, our study found that when the number of polyps removed was
greater than or equal to 3, the risk of DPPB was higher, which was consistent with the conclusions

of previous studies [3, 6] . A higher number of removed polyps was associated with a greater the risk
of DPPB. Previous studies have reported that polyp size was one of the important factors affecting
the incidence of DPPB [13, 15, 21, 23] . Our meta-analysis also found that a larger polyp size was
associated with a greater risk of DPPB, especially when the size of the removed polyp was greater

than 10 mm. This association may be due to larger polyps’ size being associated with more
nourishing blood vessels, larger wound caused by resection, a greater extent of damage to blood
vessels, and increased difficulty with repairing the blood vessels. Regarding polyp morphology,

pedunculated polyp has also been confirmed to be an independent risk factor for DPPB. This effect
might be related to the fact that pedunculated polyps usually have large-diameter blood supplying
vessels passing through the pedicle to supply blood to the head of the polyp [29] , the involved vessels
are thicker [30] , and the exposed vessels after polypectomy lead to an increased risk of bleeding [22] . It

remains unclear whether polyp location affects the risk of DPPB after colorectal polypectomy. Que
et al. reported that the position of polyps in the right half colon or rectum was a risk factor for
delayed postoperative bleeding [12] . Eleftheriadis D et al. found that delayed bleeding was more
likely to occur after right half colon polypectomy [11] . However, Inagaki Y et al. found that DPPB

[7]
was more likely to occur when the lesions were in the rectum . The results of this study showed
that the removal of polyps located in the right colon increased the risk of DPPB. Previous studies
[15, 18, 19, 22, 23] suggest that this association may be related to the histological variation in colon
location (thinner submucosa) and the different manipulation techniques required at this site [19].

Some factors were significantly correlated with an increased risk of DPPB in the univariate logistic
regression analysis but not in the multivariate logistic regression analysis, including cardiovascular
history, clopidogrel medication history, polyp number > 3, polyp pathological type malignant tumor,

EMR, and HB (protective factor). The reason for this inconsistency may be the existence of a false
correlation or indirect correlation between these factors and the occurrence of DPPB. Once other
factors are added, the false correlation disappears, indicating that they may not actually be risk
factors for the occurrence of DPPB. Furthermore, this inconsistency may indicate potential
publication bias.

5. Conclusion

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