Yonsei Med J.  2014 Sep;55(5):1281-1288. 10.3349/ymj.2014.55.5.1281.

Child-Pugh Score Is an Independent Risk Factor for Immediate Bleeding after Colonoscopic Polypectomy in Liver Cirrhosis

• Lee S
• Park SJ
• Cheon JH
• Kim TI
• Kim WH
• Kang DR
• Hong SP

• KMID: 1799492
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1281

Abstract

PURPOSE
Post-polypectomy bleeding is the most common colonoscopic polypectomy complication. However, the risk of post-polypectomy bleeding in liver cirrhosis is unknown. We aimed to evaluate the risk of post-polypectomy bleeding in patients with liver cirrhosis.
MATERIALS AND METHODS
We included 89 patients with liver cirrhosis who received colonoscopic polypectomy between January 2006 and October 2012. Three hundred forty-eight subjects without liver disease who underwent colonoscopic polypectomy comprised the control group. Risks of post-polypectomy bleeding were analyzed according to patient- and polyp-related factors.
RESULTS
Among 89 patients, 75 (84.3%) were Child-Pugh class A, 10 (11.2%) were class B, and 4 (4.5%) were class C. Incidence of immediate post-polypectomy bleeding was significantly increased in cirrhosis with Child-Pugh class B or C compared to liver cirrhosis with Child-Pugh class A or control group [hazard ratio (HR) 3.5; p<0.001]. Polyp size (HR 3.6; p=0.032) and pedunculated polyps (HR 2.4; p=0.022) were also significant risk factors for immediate post-polypectomy bleeding in multivariate analysis.
CONCLUSION
Cirrhotic patients with Child-Pugh class B or C have a high risk of immediate post-polypectomy bleeding. Thus, endoscopists should be cautious about performing colonoscopic polypectomy in patients with Child-Pugh class B or C.

Keyword

Bleeding; colonoscopy; liver cirrhosis; colorectal polyps; polypectomy

MeSH Terms

Aged
Colonoscopy/*adverse effects
Female
Gastrointestinal Hemorrhage/*epidemiology
Humans
Incidence
Liver Cirrhosis/complications/*surgery
Male
Middle Aged
Postoperative Hemorrhage/*epidemiology
Retrospective Studies
Risk Factors
Time Factors

Figure

• 

  Fig. 1 Study design. IPPB, immediate post-polypectomy bleeding; DPPB, delayed post-polypectomy bleeding.

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