Safety Analysis Of Colonic Polyp Removal By CSP In Elderly Patients With Long-Term Oral NSAIDs

Objective: Cold snare polypectomy(CSP)has obvious clinical effect and safety side effect in removing intestinal polyps.The elderly patients with intestinal polyp who take NSAIDs for a long time have more fragile intestinal function and higher probability of ulcerative bleeding,which makes intestinal polyp resection more difficult and its safety is worth further investigation.This paper further explores the clinical efficacy and safety of CSP after intestinal polyp resection in elderly patients who take NSAIDs for a long time.To provide more theoretical basis for the application value of CSP in endoscopic treatment of colonic polyps in elderly patients.Methods: From January 2021 to January 2022,85 elderly patients who received colorectal resection and long-term administration of NSAIDs in the department of Gastroenterology of our hospital were selected as the research objects.They were divided into HSP group and CSP group according to the operation method.General sociological data,perioperative indicators(operative time,single polyp removal time,intraoperative blood loss,intraoperative titanium clip utilization rate,complete polyp removal rate)and other differences between the two groups were analyzed.The incidence difference of postoperative complications(delayed perforation,bleeding,abdominal discomfort)between the two groups was analyzed.Differences in postoperative pathological classification,atypia and submucosal cumulative injury;ADL quality of life scores were different between the two groups before surgery,immediately after surgery,6 months after surgery and 12 months after surgery.Univariate and multivariate Logistic regression were used to analyze the risk factors of delayed bleeding.Results: Two groups of patients’ average age,sex ratio(male,female),the scores for intestinal preparation,the per capita number of polyps,polyp diameter,the NICE classification(type Ⅰ,Ⅱ,Ⅲ),polyps,the recovery rate of specimens,atypia(low level intraepithelial neoplasia,high-grade intraepithelial neoplasia,without atypia)and pathological results(hyperplastic polyp,tubular adenoma,villous adenoma,tubular villi Adenoma,inflammatory polyp)and NSAIDs(salicylic acids,pyrazolones,indoles,aminoids),there was no statistical significance(P>0.05).Compared with HSP group,the removal time of single polyp,intraoperative bleeding,histological intact resection rate and the proportion of submucosal injury in CSP group were significantly reduced,with statistical significance(P<0.05).In the HSP group,there were 3 cases of delayed bleeding,2 cases of delayed perforation,17 cases of abdominal discomfort(nausea,vomiting,melena)and 2 cases of recurrence within 1 month after surgery.In THE CSP group,there were no delayed perforation patients,and there were 1 patients with delayed bleeding,7 patients with abdominal discomfort and 1 patient with recurrence.The incidence of complications between the two groups was statistically significant(P<0.05).The ADL scale scores of patients in the two groups showed a trend of decrease and increase after surgery,and the ADL score of CSP group was higher than that of HSP group at 1 and 6 months after surgery,with statistical significance(P<0.05).There was no statistical significance in the incidence of complications among patients taking different NSAIDs(P>0.05).Age,gender,intestinal preparation score,pathological type,size of polyp and type of NSAIDs had little influence on postoperative delayed bleeding(P>0.05).The histological resection rate,mucosal injury,inflammatory factor level and surgical method had significant influence on postoperative delayed bleeding(P<0.05).Conclusions: CSP in long-term oral NSAIDS colon polyps resection in the elderly postoperative reflects the higher safety,compared with HSP,CSP can significantly shorten the average of colon polyps resection,postoperative bleeding risk of perforation is relatively lower,reduce the body’s inflammatory response,improve the patients quality of life,is a simple and effective way of security,It is worthy of further promotion in clinical practice.