Risk Factors for Delayed Post-Polypectomy Bleeding

Abstract

Background/AimsAmong the many complications that can occur following therapeutic endoscopy, bleeding is the most serious, which occurs in 1.0-6.1% of all colonoscopic polypectomies. The aim of this study was to identify risk factors of delayed post-polypectomy bleeding (PPB).MethodsWe retrospectively reviewed the data of patients who underwent colonoscopic polypectomy between January 2003 and December 2012. We compared patients who experienced delayed PPB with those who did not. The control-to-patient ratio was 3:1. The clinical data analyzed included polyp size, number, location, and shape, patient' body mass index (BMI), preventive hemostasis, and endoscopist experience.ResultsOf 1,745 patients undergoing colonoscopic polypectomy, 21 (1.2%) experienced significant delayed PPB. We selected 63 age- and sex-matched controls. Multivariate logistic regression analysis showed that polyps >10 mm (odds ratio [OR], 2.605; 95% confidence interval [CI], 1.035-4.528; P=0.049), a pedunculated polyp (OR, 3.517; 95% CI, 1.428-7.176; P=0.045), a polyp located in the right hemicolon (OR, 3.10; 95% CI, 1.291-5.761; P=0.013), and a high BMI (OR, 3.681; 95% CI, 1.876-8.613; P=0.013) were significantly associated with delayed PPB.ConclusionsAlthough delayed PPB is a rare event, more caution is needed during colonoscopic polypectomies performed in patients with high BMI or large polyps, pedunculated polyps, or polyps located in the right hemicolon.

Association between the ulcer status and the risk of delayed bleeding after the endoscopic mucosal resection of colon

“…We noted also that larger polyp size was a risk factor for DPPB, consistent with previous studies. 12,13 We suggest that larger polyps may have a greater number of feeding vessels, which would consequently increase the probability of cut vessels and thereby increase the risk of DPPB. Furthermore, larger polyps may require a greater extent of electrocoagulation for EMR.…”

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

“…Referring to prior literature, the present study also displayed polyp size as a conspicuous risk factor. Min and colleagues discovered that the incidence rate was 2.6‐fold higher for polyps larger than 1 cm than for smaller polyps . Another study reported that every 1‐mm increase in polyp size increased the incidence rate by 11.6% .…”

Clinical outcome of endoscopic management in delayed postpolypectomy bleeding

“…Methods other than clipping were more frequently used in the rebleeding positive group. The choice of hemostatic method apparently depends on an individual endoscopist's preference 1215. A combination of several methods was required in some cases.…”

“…Most DPPB is detected when patients complain of hematochezia several hours to several days after colonoscopic polypectomy. The incidence of DPPB is reported to be 0.2% to 2.2% 6781112. Although most endoscopists apply endoscopic hemostasis to manage DPPB, clinical outcomes of endoscopic management have not been thoroughly investigated.…”