Postpolypectomy lower GI bleeding: Descriptive analysis

Sorbi, Darius; Norton, Ian D.; Conio, Mássimo; Balm, Rita K.; Zinsmeister, Alan R.; Gostout, Christopher J.

doi:10.1067/mge.2000.105773

Cited by 226 publications

(146 citation statements)

References 24 publications

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“…Usually intra-procedure in gastric lesions, occurring in 3.4% to 7.2% and delayed in duodenum, reported in 3.1%-22% of patients [2,26]. In colorectal polypectomy, bleeding occurs in 0.3% to 6.1% [27]. Evidence that aspirin or NSAIDs increase the risk of bleeding after polypectomy is lacking.…”

Section: Polypectomymentioning

confidence: 99%

Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Best Practice & Research Clinical Gastroenterology

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Keywords:GI endoscopy adverse events GI emergencies Bleeding Haemorrhage Perforation Infection Embolization Diagnosis and management of severe complications a b s t r a c t Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.

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Section: Polypectomymentioning

confidence: 99%

Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Best Practice & Research Clinical Gastroenterology

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“…The risk of bleeding in both cases varies based on the size and type of the polyps and their location. Specifically, the resection of polyps larger than 2 cm is associated with a greater risk of complications, 7 mainly digestive bleeding. In order to avoid post-polypectomy bleeding, various hemostatic techniques have been developed for prophylactic use, 8 such as the endoloop, adrenaline injection and hemoclip.…”

Section: Introdutionmentioning

confidence: 99%

“…The size is an important risk factor of bleeding. The resection of polyps larger than 2 cm is associated with a greater risk of complications, 7 mainly digestive bleeding. The endoscopist who carried out the polipectomy, had 30 years' experience.…”

mentioning

confidence: 99%

Is the use of prophylactic hemoclips in the endoscopic resection of large pedunculated polyps useful? A prospective and randomized study

Quintanilla¹,

Castro²,

Rábago³

et al. 2012

jig

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Background:The methods for preventing post-polypectomy bleeding (PPB) are not standardised and there are groups that use hemoclips for this purpose. Objective: To study whether the use of hemoclips reduces PPB complications. Materials and Methods: Prospective, randomised study of patients with pedunculated polyps larger than 10 mm. The patients were included in two groups (hemoclip before polypectomy -HC-and standard polypectomy -SP-). This study has been registered with the trial registration number NCT01565993. Results: 105 polypectomies were performed (98 patients), 66 (62.9%) in the HC group. The total rate of complications was 10,6% in the HC group (4.5% early bleeding, 1.5% severe delayed bleeding, 4,5% mucosal burns, 1.5% perforation). In the SP group, the rate of total complications was 7,7%, (7,7% early bleeding, no significant differences). In view of the unexpected increase in the morbidity of the hemoclip group, the study was suspended without reaching the sample size. In an ad hoc analysis, which includes the standard polypectomy patients who refused to participate in the study (35 polyps), the total morbidity was 5,7% (no perforations and 2 patients with premature bleeding).When we compared the morbidity of the HC group to the morbidity of SP group plus R group (74 polyps), we also failed to detect any significant differences in terms of PPB, but did in terms of perforation. Conclusion:The prophylactic use of hemoclips in polypectomies of large pedunculated polyps leads to a further risk of mucosal burns and perforation that is not acceptable, and does not reduce the risk of PPB.

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“…Bleeding can be categorized as either immediate or delayed depending on the onset time. Immediate bleeding just after the procedure can be easily managed with recent advancing endoscopic technology and hemostasis equipment [4][5][6] , but delayed hemorrhages causes more serious problem because of unpredictable onset and occurrence after hospital discharge [3,7] . Several research studies showed that locations and the types of polyp could be risk factors for delayed bleeding [4,7,8] .…”

Section: Introductionmentioning

confidence: 99%

“…Immediate bleeding just after the procedure can be easily managed with recent advancing endoscopic technology and hemostasis equipment [4][5][6] , but delayed hemorrhages causes more serious problem because of unpredictable onset and occurrence after hospital discharge [3,7] . Several research studies showed that locations and the types of polyp could be risk factors for delayed bleeding [4,7,8] . However, the size of the polyp was determined to be the most reliable factor for delayed bleeding [8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

What can be the criteria of outpatient-based endoscopic resection for colon polyp?

Kim

Cho

2014

WJGE

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AIM:To investigate whether out-patient based endoscopic mucosal resection (EMR) for colon polyps ≤ 10 mm is safe. METHODS:Between January 2004 and December 2012, a total of 3015 EMR cases conducted in 1320 patients were retrospectively reviewed. The factors contributing delayed hemorrhage were analyzed. We calculated the probability of delayed bleeding after stratifying conditions of specific risk factors. RESULTS:The size of the polyp (95%CI: 1.096-1.164, P < 0.001) and patients with chronic renal failure (95%CI: 1.856-45.106, P = 0.007) were identified as independent risk factors for delayed bleeding in multivariate analysis. 95%CI for percent of delayed bleeding according to polyp size was determined for the following conditions: size ≤ 10 mm, 0.05%-0.43%; 20 mm ≥ size > 10 mm, 0.54%-2.08%; size > 20 mm, 4.22%-11.41%. 95%CI was determined for the risk of serious immediate bleeding for a polyp ≤ 10 mm was 0.10%-0.56%. Finally, 95%CI for percent of incomplete resection was 0.07%-0.49% in polyps ≤ 10 mm. CONCLUSION:It seems acceptable to perform outpatient-based EMR for colon polyps ≤ 10 mm. Key words: Colon; Polyp; Endoscopic mucosal resection; Bleeding Core tip: There has been a belief that it is safe to perform outpatient-based endoscopic mucosal resection (EMR) for a colon polyp ≤ 10 mm. We found out that the risk of delayed bleeding was 0.05% to 0.43% and that the risk of serious immediate bleeding was 0.10% to 0.56% in polyps ≤ 10 mm. From these results, we induced the conclusion that outpatient-based EMR for polyps no more than 10 mm can be performed without serious concern.Kim HH, Kim SE, Cho EJ. What can be the criteria of outpatientbased endoscopic resection for colon polyp? World J Gastrointest

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Postpolypectomy lower GI bleeding: Descriptive analysis

Cited by 226 publications

References 24 publications

Emergencies after endoscopic procedures

Emergencies after endoscopic procedures

Is the use of prophylactic hemoclips in the endoscopic resection of large pedunculated polyps useful? A prospective and randomized study

What can be the criteria of outpatient-based endoscopic resection for colon polyp?

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