Risk factors for delayed post-polypectomy bleeding

Abstract

Background/aims: Among 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).

Methods: We 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.

Results: Of 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.

Conclusions: Although 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.

Keywords: Colonoscopy; Complication; Hemorrhage; Polypectomy.

Fig. 1. (A) Colon polypectomy. Snare closed at the base of the polyp. (B) Base of the polyp after polypectomy. No immediate bleeding occurred. (C) Delayed post-polypectomy bleeding. Three days later, the patient complained of hematochezia, and fresh blood and clots were observed on endoscopy. (D) Endoscopic treatment. Endoscopic clipping for the treatment of delayed post-polypectomy bleeding was performed.