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. 2024 Jan 5;14(2):127.
doi: 10.3390/diagnostics14020127.

Analysis of Predictors and Risk Factors of Postpolypectomy Syndrome

Stefano Fusco  1 , Michelle E Bauer  1 , Ulrike Schempf  1 , Dietmar Stüker  1 , Gunnar Blumenstock  2 , Nisar P Malek  1 , Christoph R Werner  1 , Dörte Wichmann  1
Affiliations

Analysis of Predictors and Risk Factors of Postpolypectomy Syndrome

Stefano Fusco et al. Diagnostics (Basel). .

Abstract

Background and aims: Postpolypectomy syndrome (PPS) is a relevant adverse event that can appear after polypectomy. Several publications mention postpolypectomy syndrome using different criteria to define it. The aim of this study is to detect potential risk factors and predictors for developing PPS and to define the main criteria of PPS.

Methods: In this retrospective monocentric study, 475 out of 966 patients who underwent colonoscopy with polypectomy from October 2015 to June 2020 were included. The main criterion of PPS is defined as the development of postinterventional abdominal pain lasting more than six hours.

Results: A total of 9.7% of the patients developed PPS, which was defined as local abdominal pain around the polypectomy area after six hours. A total of 8.6% of the study population had abdominal pain within six hours postintervention. A total of 3.7% had an isolated triad of fever, leukocytosis, and increased CRP in the absence of abdominal pain. Increased CRP combined with an elevated temperature over 37.5 °C seems to be a positive predictor for developing PPS. Four independent risk factors could be detected: serrated polyp morphology, polypoid configurated adenomas, polyp localization in the cecum, and the absence of intraepithelial neoplasia.

Conclusions: Four independent risk factors for developing PPS were detected. The combination of increased CRP levels with elevated temperature seems to be a predictor for this pathology. As expected, the increasing use of cold snare polypectomies will reduce the incidence of this syndrome. Key summary: Our monocentric study on 966 patients detected four independent risk factors for developing PPS: pedunculated polyp, resected polyps in the cecum, absence of IEN, and serrated polyp morphology. The combination of increased CRP levels with elevated temperature seems to be a predictor for this pathology.

Keywords: PPS; abdominal pain; adenoma; colonoscopy; polyp; postpolypectomy syndrome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient identification and inclusion.
Figure 2
Figure 2
Polyp configuration of the control cohort (Paris classification).
Figure 3
Figure 3
Polyp configuration of the PPS cohort (Paris classification).
Figure 4
Figure 4
Histological grading of the resected polyps.
Figure 5
Figure 5
Overview of localization of polypectomies in the control group (n = 1156).
Figure 6
Figure 6
Overview of localization of polypectomies in the PPS group (n = 133).
Figure 7
Figure 7
Polyp size in mm in control group and PPS group.
Figure 8
Figure 8
Diagnostic and therapeutic algorithm for suspected PPS.
See this image and copyright information in PMC

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References

    1. Waye J.D., Lewis B.S., Yessayan S. Colonoscopy: A prospective report of complications. J. Clin. Gastroenterol. 1992;15:347–351. doi: 10.1097/00004836-199212000-00018. - DOI - PubMed
    1. Dafnis G., Ekbom A., Pahlman L., Blomqvist P. Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden. Gastrointest. Endosc. 2001;54:302–309. doi: 10.1067/mge.2001.117545. - DOI - PubMed
    1. Viiala C.H., Zimmerman M., Cullen D.J.E., Hoffman N.E. Complication rates of colonoscopy in an Australian teaching hospital environment. Intern. Med. J. 2003;33:355–359. doi: 10.1046/j.1445-5994.2003.00397.x. - DOI - PubMed
    1. Lee H., Cheoi K.S., Chung H., Park J.C., Shin S.K., Lee S.K., Lee Y.C. Clinical features and predictive factors of coagulation syndrome after endoscopic submucosal dissection for early gastric neoplasm. Gastric Cancer. 2012;15:83–90. doi: 10.1007/s10120-011-0073-x. - DOI - PubMed
    1. Ito S., Hotta K., Imai K., Yamaguchi Y., Kishida Y., Takizawa K., Kakushima N., Tanaka M., Kawata N., Yoshida M., et al. Risk factors of post-endoscopic submucosal dissection electrocoagulation syndrome for colorectal neoplasm. J. Gastroenterol. Hepatol. 2018;33:2001–2006. doi: 10.1111/jgh.14302. - DOI - PubMed