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. 2014 Oct 1;9(10):e108290.
doi: 10.1371/journal.pone.0108290. eCollection 2014.

Assessment of risk factors for delayed colonic post-polypectomy hemorrhage: a study of 15553 polypectomies from 2005 to 2013

Qiang Zhang  1 , Sheng li An  2 , Zhen yu Chen  1 , Feng-Hua Fu  1 , Bo Jiang  1 , Fa chao Zhi  1 , Yang Bai  1 , Wei Gong  1
Affiliations

Assessment of risk factors for delayed colonic post-polypectomy hemorrhage: a study of 15553 polypectomies from 2005 to 2013

Qiang Zhang et al. PLoS One. .

Abstract

Background and aim: Delayed colonic postpolypectomy bleeding is the commonest serious complication after polypectomy. This study aimed to utilize massive sampling data of polypectomy to analyze risk factors for delayed postpolypectomy bleeding.

Patients and methods: The endoscopic data of 5600 patients with 15553 polyps removed (2005 to 2013) were analyzed retrospectively through univariate analysis and multiple logistic regression analysis to evaluate the risk factors for delayed bleeding.

Results: Delayed postpolypectomy bleeding occurred in 99 polyps (0.6%). The rates of bleeding for different polypectomy methods including hot biopsy forcep, biopsy forcep, Argon Plasma Coagulation (APC), Endoscopy piecemeal mucosal resection (EPMR), Endoscopic Mucosal Resection (EMR), and snare polypectomy were 0.1%, 0.0%, 0.0%, 6.9%, 0.9% and 1.0%, respectively. The risk factors for delayed bleeding were the size of polyps over 10 mm (odds ratio [OR] = 4.6, 95% CI, 2.9-7.2), pathology of colonic polyps (inflammatory/hyperplastic, OR = 1; adenomatous, OR = 1.4, 95% CI, 0.7-2.6; serrated, OR = 1.5, 95% CI, 0.2-11.9; juvenile, OR = 4.3, 95% CI, 1.8-11.0; Peutz-Jegher, OR = 3.3, 95% CI, 1.0-10.7), and immediate postpolypectomy bleeding (OR = 2.9, 95% CI, 1.4-5.9). In addition, although polypectomy method was not a risk factor, compared with hot biopsy forcep, snare polypectomy, EMR, and EPMR had increased risks of delayed bleeding, with ORs of 3.2 (0.4-23.3), 2.8 (0.4-21.7) and 5.1 (0.5-47.7), respectively.

Conclusion: Polyp size over 10 mm, pathology of colonic polyps (especially juvenile, Peutz-Jegher), and immediate postpolypectomy bleeding were significant risk factors for delayed postpolypectomy bleeding.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The number of cases of delayed bleeding, and time interval between the time of polypectomy and the occurrence of delayed hemorrhage.
0 day, 1st day, 2nd day, et al represent the time intervals.
See this image and copyright information in PMC

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