Complications of endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection in the colon

Michael, X.; Bourke, Michael J.

doi:10.1016/j.bpg.2016.09.009

Cited by 76 publications

(49 citation statements)

References 87 publications

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“…66 For PPB occurring after sessile polyp removal, the goal is to directly tamponade the underlying blood vessel by maneuvering the clip and opposing the mucosa on both sides of the defect, when possible. 67 For very large endoscopic resection, the adjacent mucosal margins may not be approximated effectively at times. To ensure hemostasis, the area should be lavaged copiously while the TTS clip is closed but not deployed.…”

Section: Management Of Post-polypectomy Bleedingmentioning

confidence: 99%

“…If the area has no re-accumulation of red blood, then clip deployment is appropriate in that position. 67 Other methods of endoscopic hemostasis include direct thermal therapy, which is performed with bipolar cautery, snare tip, or thermal probes. In addition, for refractory oozing PPB, coagulation therapy with argon plasma coagulation can be applied to the resection bed.…”

Section: Management Of Post-polypectomy Bleedingmentioning

confidence: 99%

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Endoscopic Management of Post-Polypectomy Bleeding

Gutta

Gromski

2020

Clin Endosc

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Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.Clin Endosc 2020;53:302-310

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Section: Management Of Post-polypectomy Bleedingmentioning

confidence: 99%

Section: Management Of Post-polypectomy Bleedingmentioning

confidence: 99%

Endoscopic Management of Post-Polypectomy Bleeding

Gutta

Gromski

2020

Clin Endosc

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“…The percentages of POB following colorectal ESD [7,11,14] are highly variable, ranging from 0.5 to 9.6%. Although the POB rate was lower following colorectal ESD than colorectal EMR in a meta-analysis [2] , life-threatening bleeding requiring blood transfusion may occur in patients treated with ESD.…”

Section: Introductionmentioning

confidence: 99%

“…As in case of EP and EMR [12,13] , postoperative bleeding (POB) and perforation are both major complications associated with ESD [14] . The percentages of POB following colorectal ESD [7,11,14] are highly variable, ranging from 0.5 to 9.6%.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

Okamoto¹,

Watanabe²,

Komeda³

et al. 2017

Oncology

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antithrombotic therapy and rectal tumor location were strongly associated with POB following colorectal ESD. The incidence of POB was higher in patients on heparin bridge therapy (HBT) for the replacement of antithrombotic therapy than in patients with no HBT. Four of 7 patients (57.1%) on antithrombotic therapy experienced POB from the rectal lesions. Conclusion: Antithrombotic therapy and rectal lesions result in a higher POB incidence after colorectal ESD.

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“…However, ESD is time consuming, technically difficult, often requires post-procedural multiday hospitalisation, and in Western countries, a limited number of endoscopists have sufficient experience with this procedure. In addition, ESD is associated with a higher risk of bleeding (10-20%) and perforation (5-10%; Table 3) [38][39][40]. Surgery Surgery, particularly laparoscopic colorectal resection is currently a widely accepted treatment for "difficult" and complex polyps not amenable to endoscopic removal.…”

Section: Endoscopic Mucosal Resectionmentioning

confidence: 99%

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

Herszényi¹

2018

Dig Dis

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Background: Colonoscopy is the gold standard for adenoma detection. All endoscopists who perform colonoscopy must by mandate be skilled to perform polypectomy. However, there are significant differences between endoscopists in terms of the polyp detection rate and in the effectiveness of polypectomy. Summary: Most polyps identified can be managed by conventional polypectomy and do not pose a significant challenge for resection to an adequately skilled and trained endoscopist. Up to 15% of polyps may be considered “difficult”, unsuitable for conventional endoscopic removal because of size, morphology, site, or access grade. Endoscopist-, patient- and polyp-specific viewpoints influence the management of difficult polyps. Advances in endoscopic resection techniques have led to extended indications for polypectomy. Conventional endoscopic removal of colorectal polyps is associated with a small but not negligible incidence of complications, most commonly bleeding and perforation. Advanced techniques for difficult polyps can potentially cause significant, even life-threatening complications. In addition, in the presence of “difficult” polyps, complications are more common. Key Messages: Multiple techniques are now available for the resection of difficult polyps. The endoscopist should individualize the appropriate approach for the treatment of difficult polyp in order to maximize oncological safety, efficacy and minimize complications and unnecessary surgery.

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Complications of endoscopic polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection in the colon

Cited by 76 publications

References 87 publications

Endoscopic Management of Post-Polypectomy Bleeding

Endoscopic Management of Post-Polypectomy Bleeding

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

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