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. 2021 Mar 1;10(5):928.
doi: 10.3390/jcm10050928.

Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

Takuya Okugawa  1 , Tadayuki Oshima  1 , Keisuke Nakai  1 , Hirotsugu Eda  1 , Akio Tamura  1 , Ken Hara  1 , Tomohiro Ogawa  1 , Tomoaki Kono  1 , Takashi Kondo  1 , Katsuyuki Tozawa  1 , Masashi Fukushima  1 , Toshihiko Tomita  1 , Hirokazu Fukui  1 , Jiro Watari  1 , Hiroto Miwa  1
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Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

Takuya Okugawa et al. J Clin Med. .

Abstract

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6-2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection.

Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared.

Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction.

Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

Keywords: antithrombotic agents; cold snare polypectomy; colorectal polyps; delayed bleeding; instruction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Representative pictures of cold snare polypectomy. (a) A 5-mm polyp in the transverse colon. (b) The mucosal defect is expanded by water irrigation and no bleeding is evident.
Figure 2
Figure 2
Flow diagram of patients and polyps. ESD: endoscopic mucosal dissection; FAP: familial adenomatous polyposis.
See this image and copyright information in PMC

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