Management and Outcomes of Bleeding Within 30 Days of Colonic Polypectomy in a Large, Real-Life, Multicenter Cohort Study

Santiago, Enrique Rodríguez de; Hernández-Tejero, María; Rivero‐Sánchez, Liseth; Ortiz, Oswaldo; Filia-Molina, Irene García de la; Foruny, José Ramón; Prieto, Héctor Miguel Marcos; García-Prada, Maria; González-Cotorruelo, A González; Turrión, Miguel Ángel de Jorge; Jiménez-Jurado, Andrea; Rodríguez-Escaja, Carlos; Castaño-García, Andrés; Outomuro, Ana Gómez; Ferre‐Aracil, Carlos; Rosa, Diego de Frutos; Pellisé, María

doi:10.1016/j.cgh.2020.03.068

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…The incidence of DPPB was higher for rectal polyps, possibly because of the abundant blood vessels in the rectal mucosa, and similar results have been reported in a Japanese study 29 . Almost half of DPPB cases do not require therapeutic intervention 30 . These factors can be used to further stratify the risk of DPPB and identify patients likely to benefit from colonoscopy.…”

Section: Discussionsupporting

confidence: 77%

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Incidence and risk factors of colorectal delayed post‐polypectomy bleeding in patients taking antithrombotics

Yan

Gao

Xie

et al. 2021

J of Digest Diseases

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Objective In this study we aimed to investigate the incidence and risk factors for delayed post‐polypectomy bleeding (DPPB) in Chinese patients taking antithrombotics including antiplatelet agents and anticoagulants. Methods A retrospective study was conducted in patients who underwent colorectal polypectomy from January 2017 to May 2020. Their demographic characteristics, features of the polyps including number, size, morphology, and location, and use of antiplatelet agents and anticoagulants were collected. The incidence and risk factors for DPPB were compared between the patients with and without antithrombotic use. Results A total of 5152 polyps from 2267 patients were resected under endoscopy. Of these patients, 35 (1.54%) experienced DPPB. Compared with the control group who did not take antithrombotics (1.18%), the incidence of DPPB was significantly higher in patients treated with heparin bridge (HB) therapy (17.39%; P < 0.001) and clopidogrel (4.88%; P = 0.022), but did not differ in patients taking aspirin (1.28%), dual antiplatelet therapy (3.70%), warfarin alone (0%), or direct oral anticoagulants (3.85%). Using the multivariate analysis, HB therapy (odds ratio [OR] 16.735, 95% confidence interval [CI] 4.320‐64.834, P < 0.001), male sex (OR 3.825, 95% CI 1.298‐11.265, P = 0.015), polyps >1 cm (OR 4.584, 95% CI 1.782‐11.794, P = 0.002) and rectal polyps (OR 8.820, 95% CI 3.968‐19.602, P < 0.001) were independently associated with a high risk of DPPB. Conclusions HB and clopidogrel therapies significantly increase the incidence of DPPB. HB therapy, male sex, polyp size and polyps located in the rectum are significant risk factors for DPPB.

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Section: Discussionsupporting

confidence: 77%

“… 29 Almost half of DPPB cases do not require therapeutic intervention. 30 These factors can be used to further stratify the risk of DPPB and identify patients likely to benefit from colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of colorectal delayed post‐polypectomy bleeding in patients taking antithrombotics

Yan

Gao

Xie

et al. 2021

J of Digest Diseases

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“…In a multicenter study of patients with postpolypectomy bleeding, 43% of the cohort did not require endoscopic hemostatic therapy; rebleeding and transfusion requirements were very low in those managed without intervention. Variables that were predictive of active bleeding at the time of colonoscopy included use of anticoagulants, left-sided polyps, prior use of electrocautery, and pedunculated polyp morphology (182).…”

Section: Postpolypectomy Bleedingmentioning

confidence: 99%

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

et al. 2022

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Acute lower gastrointestinal bleeding (LGIB) is a common reason for hospitalization in the United States and is associated with significant utilization of hospital resources, as well as considerable morbidity and mortality. These revised guidelines implement the Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the use of risk stratification tools, thresholds for red blood cell transfusion, reversal agents for patients on anticoagulants, diagnostic testing including colonoscopy and computed tomography angiography (CTA), endoscopic therapeutic options, and management of antithrombotic medications after hospital discharge. Important changes since the previous iteration of this guideline include recommendations for the use of risk stratification tools to identify patients with LGIB at low risk of a hospital-based intervention, the role for reversal agents in patients with life-threatening LGIB on vitamin K antagonists and direct oral anticoagulants, the increasing role for CTA in patients with severe LGIB, and the management of patients who have a positive CTA. We recommend that most patients requiring inpatient colonoscopy undergo a nonurgent colonoscopy because performing an urgent colonoscopy within 24 hours of presentation has not been shown to improve important clinical outcomes such as rebleeding. Finally, we provide updated recommendations regarding resumption of antiplatelet and anticoagulant medications after cessation of LGIB.

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“…This is similar to a recent multi-centre cohort where 43% did not require therapy. 97 Predictors of the need for endoscopic intervention were active use of anticoagulation, left-sided polyps, prior electrocautery and pedunculated morphology. 97 …”

Section: Reducing the Risk Of Dppbmentioning

confidence: 99%

“… 97 Predictors of the need for endoscopic intervention were active use of anticoagulation, left-sided polyps, prior electrocautery and pedunculated morphology. 97 …”

Section: Reducing the Risk Of Dppbmentioning

confidence: 99%

Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

Bendall¹,

Ja²,

Pawlak³

et al. 2021

CEG

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Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3–1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summary of factors that contribute to the risk of DPPB before discussing pragmatic interventions to mitigate their risk and improve patient safety.

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Management and Outcomes of Bleeding Within 30 Days of Colonic Polypectomy in a Large, Real-Life, Multicenter Cohort Study

Cited by 16 publications

References 24 publications

Incidence and risk factors of colorectal delayed post‐polypectomy bleeding in patients taking antithrombotics

Incidence and risk factors of colorectal delayed post‐polypectomy bleeding in patients taking antithrombotics

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

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