Korean J Gastroenterol.  2012 Jun;59(6):423-427. 10.4166/kjg.2012.59.6.423.

Risk Factors of Delayed Bleeding after Colonoscopic Polypectomy: Case-Control Study

• Bae GH
• Jung JT
• Kwon JG
• Kim EY
• Park JH
• Seo JH
• Kim JY

• KMID: 1792847
• DOI: http://doi.org/10.4166/kjg.2012.59.6.423

Abstract

BACKGROUND/AIMS
Colonoscopic polypectomy is a valuable procedure for preventing colorectal cancer, but is not without complications. Delayed bleeding after colonoscopic polypectomy is a rare, but serious complication. The aim of this study was to identify risk factors of delayed bleeding after colonoscopic polypectomy.
METHODS
A retrospective case-control study was conducted in a single university hospital. Forty cases and 120 controls were included. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, endoscopist's experience, resection method, use of sedation, and use of prophylactic hemostasis.
RESULTS
In univariate analysis, size, histology and number of resected polyps, endoscopist's experience, resection method and use of prophylactic hemostasis were significant risk factors for delayed bleeding after colonoscopic polypectomy. In multivariate analysis, risk of delayed bleeding increased by 11.6% for every 1 mm increase in resected polyp diameter (OR, 1.116; 95% CI 1.041-1.198; p=0.002). Number of resected polyps (OR, 1.364; 95% CI, 1.113-1.671; p=0.003) and endoscopist's experience (OR, 6.301; 95% CI, 2.022-19.637; p=0.002) were significant risk factors for delayed bleeding after colonoscopic polypectomy.
CONCLUSIONS
Size and numbers of resected polyps, and endoscopist's experience were independent risk factors for delayed bleeding after colonoscopic polypectomy. More caution would be necessary when removing polyps with these factors.

Keyword

Bleeding; Polypectomy; Colonoscopy; Complication

MeSH Terms

Adult
Aged
Case-Control Studies
Colonic Diseases/*diagnosis/pathology
Colonic Polyps/*surgery
Colonoscopy/adverse effects
Female
Gastrointestinal Hemorrhage/*etiology
Humans
Male
Middle Aged
Postoperative Hemorrhage/etiology
Retrospective Studies
Risk Factors

Reference

1. Anually incidence, crude incidence rate, and age-standardized incidence rate of major cancer in Korea [Internet]. 2010. cited 2011 Aug 15. Goyang (Korea): National Cancer Information Center;Available from: www.cancer.go.kr.

2. Winawer SJ, Zauber AG, Ho MN, et al. The National Polyp Study Workgroup. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993. 329:1977–1981.

3. Kim YS, Lee DS, Jung JJ, et al. Complication of colonoscopic polypectomy. Korean J Gastrointest Endosc. 2000. 21:917–923.

4. Heldwein W, Dollhopf M, Rösch T, et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy. 2005. 37:1116–1122.

5. Rathgaber SW, Wick TM. Colonoscopy completion and complication rates in a community gastroenterology practice. Gastrointest Endosc. 2006. 64:556–562.

6. Kim DH, Lim SW. Analysis of delayed postpolypectomy bleeding in a colorectal clinic. J Korean Soc Coloproctol. 2011. 27:13–16.

7. Buddingh KT, Herngreen T, Haringsma J, et al. Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage: a multi-center case-control study. Am J Gastroenterol. 2011. 106:1119–1124.

8. Hui AJ, Wong RM, Ching JY, Hung LC, Chung SC, Sung JJ. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc. 2004. 59:44–48.

9. Macrae FA, Tan KG, Williams CB. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut. 1983. 24:376–383.

10. Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy. 2008. 40:115–119.

11. Li LY, Liu QS, Li L, et al. A meta-analysis and systematic review of prophylactic endoscopic treatments for postpolypectomy bleeding. Int J Colorectal Dis. 2011. 26:709–719.

12. Fatima H, Rex DK. Minimizing endoscopic complications: colonoscopic polypectomy. Gastrointest Endosc Clin N Am. 2007. 17:145–156.

13. Rosen L, Bub DS, Reed JF 3rd, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum. 1993. 36:1126–1131.

14. Baillie J. Postpolypectomy bleeding. Am J Gastroenterol. 2007. 102:1151–1153.

15. Lee CK, Lee SH, Park JY, et al. Prophylactic argon plasma coagulation ablation does not decrease delayed postpolypectomy bleeding. Gastrointest Endosc. 2009. 70:353–361.

16. Shioji K, Suzuki Y, Kobayashi M, et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2003. 57:691–694.

17. Church JM. Experience in the endoscopic management of large colonic polyps. ANZ J Surg. 2003. 73:988–995.

18. Cipolletta L, Bianco MA, Rotondano G, Catalano M, Prisco A, De ST. Endoclip-assisted resection of large pedunculated colon polyps. Gastrointest Endosc. 1999. 50:405–406.

19. Watabe H, Yamaji Y, Okamoto M, et al. Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc. 2006. 64:73–78.

20. Yousfi M, Gostout CJ, Baron TH, et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol. 2004. 99:1785–1789.

21. Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc. 2000. 51:690–696.