Computerized Imaging of Vessels in EMR Defects Predicts Postprocedural Bleeding

Recent studies indicate that prophylactic clip closure of postendoscopic mucosal resection defects from colonic lesions >20 mm in size and proximal to the splenic flexure reduces the risk of delayed bleeding. However, the clipping process is expensive and time-consuming. Better prediction of bleeding could improve lesion selection for prophylactic clip closure and save money. 

In a proof-of-concept study, 43 patients with clinically significant postendoscopic bleeding underwent computer-image analysis of the blood vessels in the defect. This group was compared to nonbleeding endoscopic mucosal resection (EMR) sites in 43 patients. A score based on 5 aspects of blood-vessel images yielded 86% sensitivity and 77% specificity for predicting bleeding. A neural network classifier that was built using the same independent predictors had 100% sensitivity and 77% specificity for identifying at-risk patients.