Risk factors for delayed hemorrhage after colonoscopic postpolypectomy: Polyp size and operative modality

Abstract

Background and Aim Delayed postpolypectomy hemorrhage is relatively common, with occasional extensive blood loss, endangering life. This study aimed to determine the factors associated with postoperative hemorrhage. Methods The study was a retrospective cohort study of patients hospitalized for colonoscopic polypectomy at the Department of Gastroenterology and Hepatology, Tenth People's Hospital of Tongji University, China, between January and December 2015. Data on gender, age, bowel preparation, location, size, number of polyps, operative modality, pathology, and operation practitioner were collected. Patients were divided into two groups based on the presence or absence of postoperative hemorrhage. Results A total of 1962 polyps were detected in patients and they underwent polypectomy; hemorrhage occurred in 41 cases. A correlation was demonstrated between postpolypectomy hemorrhage and each of the following factors: polyp size and operative modality. The odds ratio (OR) was 4.535 (95% confidence interval [CI], 2.331–8.823) for 1–2‐cm polyps, 4.008 (95% CI, 0.904–17.776) for 2–3‐cm polyps, and 22.407 (95% CI, 5.783–86.812) for ≥3‐cm polyps. Compared with argon plasma coagulation, OR was 9.128 (95% CI, 3.548–23.486) for endoscopic mucosal resection and 31.257 (95% CI, 7.009–139.395) for endoscopic submucosal dissection. Conclusions The independent risk factors for delayed postpolypectomy hemorrhage include polyp size and operative modality.

Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis

“…After removal of duplicates, 895 were excluded based on study title and abstract, and 212 underwent full text review, of which 21 articles comparing ESD with EMR in resection of colorectal polyps were subsequently included in the meta-analysis (Figure 1 )[ 8 - 16 , 26 - 37 ]. In total, 12 originated from Japan[ 26 - 37 ], five from European[ 10 - 13 , 16 ], three from South Korea[ 8 , 9 , 14 ] and one from China[ 15 ]. Of the 21 studies, there were 17 retrospective cohort studies, two prospective cohort studies and two retrospective case-control studies.…”

Risk factors for post-polypectomy bleeding; a retrospective case-control study of a high-volume colonoscopy center

“…Its incidence lies between 0.3 -3.8 % of patients. Higher rates of delayed bleeding are associated with the removal of larger polyps (> 20 mm) [4,5,6,7,8,9]; furthermore, in patients receiving anticoagulation therapy or bridging with low molecular weight heparin, the incidence of delayed bleeding may increase to 11 % [10,11]. A limitation in all these studies was the rarity of delayed bleeding, resulting in low statistical power.…”

Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for Colorectal Polyps. A Meta-Analysis 

“…1). [9][10][11][12][13][14][15][16][17][27][28][29][30][31][32][33][34][35][36][37][38] In total, 12 originated from Japan [27][28][29][30][31][32][33][34][35][36][37][38] , ve from European [11][12][13][14]17 , three from South Korea 9, 10, 15 and one from China 16 . Of the 21 studies, there were 17 retrospective cohort studies, two prospective cohort studies and two retrospective case-control studies.…”

“…Previous meta-analyses and systematic reviews comparing ESD with EMR mainly focused on data reported from Asian countries with limited data coming from outside of Japan, without controlling for confounders or lesions <20mm. 7,8 Since then, numerous studies comparing between ESD and EMR have been reported from the West and other countries [9][10][11][12][13][14][15][16][17] We sought to perform an expanded meta-analysis to include lesions ≤20mm, and incorporate regression analysis to control for confounders.…”