Prediction of Immediate Bleeding After Cold Snare Polypectomy

Abstract

We aimed to identify risk factors and develop a predictive risk-scoring model for immediate post-polypectomy bleeding (IPPB) after cold snare polypectomy (CSP). This multicenter prospective observational study included 161 polyps (4-9 mm in diameter) that were removed via CSP from 118 patients between June and September 2019. IPPB was defined as post-polypectomy bleeding within 24 h or grade 3/4 intraprocedural bleeding requiring endoscopic hemostasis. IPPB incidences according to grade were 13.0% (21/161) (grade 3) and 0% (grade 4). Univariate analysis showed that polyp size, morphology, and iatrogenic ulcer size and shape were significantly associated with IPPB. Multivariate analysis showed that polyp size [6-9 mm vs. 4-5 mm, odds ratio (OR) 3.72, 95% confidence interval (CI) 1.28-10.79], polyp morphology (polypoid vs. non-polypoid, OR: 3.93, 95% CI: 1.22-12.64), and iatrogenic ulcer size (≥ 10 vs. ≤ 9 mm, OR: 3.12, 95% CI: 1.04-9.38) were significantly associated with IPPB. We created a four-marker risk-scoring model to predict IPPB after CSP; we summed the points assigned for the four factors. At a cut-off of 2, the sensitivity was 85.7% and the specificity was 65.0%; at a cut-off of 3, the sensitivity was 65% and the specificity was 90.0%. The four-marker risk-scoring model appears to effectively predict IPPB after CSP.