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Published in:

01-07-2018

Prospective analysis of delayed colorectal post-polypectomy bleeding

Authors: Soo-Kyung Park, Jeong Yeon Seo, Min-Gu Lee, Hyo-Joon Yang, Yoon Suk Jung, Kyu Yong Choi, Hungdai Kim, Hyung Ook Kim, Kyung Uk Jung, Ho-Kyung Chun, Dong Il Park

Published in: Surgical Endoscopy | Issue 7/2018

Abstract

Backgrounds/aims

Although post-polypectomy bleeding is the most frequent complication after colonoscopic polypectomy, only few studies have investigated the incidence of bleeding prospectively. The aim of this study was to investigate the incidence of delayed post-polypectomy bleeding and its associated risk factors prospectively.

Methods

Patients who underwent colonoscopic polypectomy at Kangbuk Samsung Hospital from January 2013 to December 2014 were prospectively enrolled in this study. Trained nurses contacted patients via telephone 7 and 30 days after polypectomy and completed a standardized questionnaire regarding the development of bleeding. Delayed post-polypectomy bleeding was categorized as minor or major and early or late bleeding. Major delayed bleeding was defined as a > 2-g/dL drop in the hemoglobin level, requiring hospitalization for control of bleeding or blood transfusion; late delayed bleeding was defined as bleeding occurring later than 24 h after polypectomy.

Results

A total of 8175 colonoscopic polypectomies were performed in 3887 patients. Overall, 133 (3.4%) patients developed delayed post-polypectomy bleeding. Among them, 90 (2.3%) and 43 (1.1%) patients developed minor and major delayed bleeding, respectively, and 39 (1.0%) patients developed late delayed bleeding. In the polyp-based multivariate analysis, young age (< 50 years; odds ratio [OR] 2.10; 95% confidence interval [CI] 1.18–3.68), aspirin use (OR 2.78; 95% CI 1.23–6.31), and polyp size of > 10 mm (OR 2.45; 95% CI 1.38–4.36) were significant risk factors for major delayed bleeding, while young age (< 50 years; OR 2.6; 95% CI 1.35–5.12) and immediate bleeding (OR 3.3; 95% CI 1.49–7.30) were significant risk factors for late delayed bleeding.

Conclusions

Young age, aspirin use, polyp size, and immediate bleeding were found to be independent risk factors for delayed post-polypectomy bleeding.

Thiis-Evensen E, Hoff GS, Sauar J, Langmark F, Majak BM, Vatn MH (1999) Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I. Scand J Gastroenterol 34(4):414–420CrossRefPubMed

Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M (2001) Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 48(6):812–815CrossRefPubMedPubMedCentral

Lin OS, Kozarek RA, Cha JM (2014) Impact of sigmoidoscopy and colonoscopy on colorectal cancer incidence and mortality: an evidence-based review of published prospective and retrospective studies. Intest Res 12(4):268–274CrossRefPubMedPubMedCentral

Waye JD, Lewis BS, Yessayan S (1992) Colonoscopy: a prospective report of complications. J Clin Gastroenterol 15(4):347–351CrossRefPubMed

Gibbs DH, Opelka FG, Beck DE, Hicks TC, Timmcke AE, Gathright JB Jr (1996) Postpolypectomy colonic hemorrhage. Dis Colon Rectum 39(7):806–810CrossRefPubMed

Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ (2000) Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 51(6):690–696CrossRefPubMed

Levin TR, Zhao W, Conell C, Seeff LC, Manninen DL, Shapiro JA, Schulman J (2006) Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med 145(12):880–886CrossRefPubMed

Luigiano C, Consolo P, Scaffidi MG, Strangio G, Giacobbe G, Alibrandi A, Pallio S, Tortora A, Melita G, Familiari L (2009) Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy 41(10):829–835CrossRefPubMed

Watabe H, Yamaji Y, Okamoto M, Kondo S, Ohta M, Ikenoue T, Kato J, Togo G, Matsumura M, Yoshida H, Kawabe T, Omata M (2006) Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc 64(1):73–78CrossRefPubMed

10.

Hui AJ, Wong RM, Ching JY, Hung LC, Chung SC, Sung JJ (2004) Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc 59(1):44–48CrossRefPubMed

11.

Macrae FA, Tan KG, Williams CB (1983) Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut 24(5):376–383CrossRefPubMedPubMedCentral

12.

Kim JH, Lee HJ, Ahn JW, Cheung DY, Kim JI, Park SH, Kim JK (2013) Risk factors for delayed post-polypectomy hemorrhage: a case-control study. J Gastroenterol Hepatol 28(4):645–649CrossRefPubMed

13.

Heldwein W, Dollhopf M, Rosch T, Meining A, Schmidtsdorff G, Hasford J, Hermanek P, Burlefinger R, Birkner B, Schmitt W (2005) The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 37(11):1116–1122CrossRefPubMed

14.

Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH (2008) Risk factors for severe delayed postpolypectomy bleeding. Endoscopy 40(2):115–119CrossRefPubMed

15.

Choung BS, Kim SH, Ahn DS, Kwon DH, Koh KH, Sohn JY, Park WS, Kim IH, Lee SO, Lee ST, Kim SW (2014) Incidence and risk factors of delayed postpolypectomy bleeding: a retrospective cohort study. J Clin Gastroenterol 48(9):784–789CrossRefPubMed

16.

Kwon MJ, Kim YS, Bae SI, Park YI, Lee KJ, Min JH, Jo SY, Kim MY, Jung HJ, Jeong SY, Yoon WJ, Kim JN, Moon JS (2015) Risk factors for delayed post-polypectomy bleeding. Intest Res 13(2):160–165CrossRefPubMedPubMedCentral

17.

Buddingh KT, Herngreen T, Haringsma J, van der Zwet WC, Vleggaar FP, Breumelhof R, Ter Borg F (2011) 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 106(6):1119–1124CrossRefPubMed

18.

Yousfi M, Gostout CJ, Baron TH, Hernandez JL, Keate R, Fleischer DE, Sorbi D (2004) Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol 99(9):1785–1789CrossRefPubMed

19.

Zhang Q, An S, Chen Z, Fu FH, Jiang B, Zhi F, Bai Y, Gong W (2014) Assessment of risk factors for delayed colonic post-polypectomy hemorrhage: a study of 15553 polypectomies from 2005 to 2013. PLoS ONE 9(10):e108290CrossRefPubMedPubMedCentral

20.

(1983) General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg 13(6):557–573

21.

Rutter MD, Nickerson C, Rees CJ, Patnick J, Blanks RG (2014) Risk factors for adverse events related to polypectomy in the English Bowel Cancer Screening Programme. Endoscopy 46(2):90–97CrossRefPubMed

22.

Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, Mallery JS, Raddawi HM, Vargo JJ, Waring JP, Fanelli RD, Wheeler-Harbough J (2002) Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastrointest Endosc 55(7):775–779CrossRefPubMed

23.

Veitch AM, Vanbiervliet G, Gershlick AH, Boustiere C, Baglin TP, Smith LA, Radaelli F, Knight E, Gralnek IM, Hassan C, Dumonceau JM (2016) Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy 48(4):385–402CrossRefPubMed

24.

Manocha D, Singh M, Mehta N, Murthy UK (2012) Bleeding risk after invasive procedures in aspirin/NSAID users: polypectomy study in veterans. Am J Med 125(12):1222–1227CrossRefPubMed

25.

Moon HS, Park SW, Kim DH, Kang SH, Sung JK, Jeong HY (2014) Only the size of resected polyps is an independent risk factor for delayed postpolypectomy hemorrhage: a 10-year single-center case-control study. Ann Coloproctol 30(4):182–185CrossRefPubMedPubMedCentral

26.

Shiffman ML, Farrel MT, Yee YS (1994) Risk of bleeding after endoscopic biopsy or polypectomy in patients taking aspirin or other NSAIDS. Gastrointest Endosc 40(4):458–462CrossRefPubMed

27.

Pan A, Schlup M, Lubcke R, Chou A, Schultz M (2012) The role of aspirin in post-polypectomy bleeding–a retrospective survey. BMC Gastroenterol 12:138CrossRefPubMedPubMedCentral

28.

Kim HS, Kim TI, Kim WH, Kim YH, Kim HJ, Yang SK, Myung SJ, Byeon JS, Lee MS, Chung IK, Jung SA, Jeen YT, Choi JH, Choi KY, Choi H, Han DS, Song JS (2006) Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol 101(6):1333–1341CrossRefPubMed

29.

Shalman D, Gerson LB (2015) Systematic review with meta-analysis: the risk of gastrointestinal haemorrhage post-polypectomy in patients receiving anti-platelet, anti-coagulant and/or thienopyridine medications. Aliment Pharmacol Ther 42(8):949–956CrossRefPubMed

30.

Bahin FF, Naidoo M, Williams SJ, Hourigan LF, Ormonde DG, Raftopoulos SC, Holt BA, Sonson R, Bourke MJ (2015) Prophylactic endoscopic coagulation to prevent bleeding after wide-field endoscopic mucosal resection of large sessile colon polyps. Clin Gastroenterol Hepatol 13(4):724–730.e721-722CrossRefPubMed

31.

Burgess NG, Metz AJ, Williams SJ, Singh R, Tam W, Hourigan LF, Zanati SA, Brown GJ, Sonson R, Bourke MJ (2014) Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol 12(4):651–661.e651-653CrossRefPubMed

32.

Metz AJ, Bourke MJ, Moss A, Williams SJ, Swan MP, Byth K (2011) Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions. Endoscopy 43(6):506–511CrossRefPubMed

33.

Lee SH, Shin SJ, Park DI, Kim SE, Jeon HJ, Kim SH, Hong SP, Hong SN, Yang DH, Lee BI, Kim YH, Kim HS, Kim HJ, Yang SK, Kim HJ (2012) Korean guideline for colonoscopic polypectomy. Clin Endosc 45(1):11–24CrossRefPubMedPubMedCentral

Title: Prospective analysis of delayed colorectal post-polypectomy bleeding
Authors: Soo-Kyung Park
Jeong Yeon Seo
Min-Gu Lee
Hyo-Joon Yang
Yoon Suk Jung
Kyu Yong Choi
Hungdai Kim
Hyung Ook Kim
Kyung Uk Jung
Ho-Kyung Chun
Dong Il Park
Publication date: 01-07-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6048-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prospective analysis of delayed colorectal post-polypectomy bleeding

Abstract

Backgrounds/aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Backgrounds/aims

Methods

Results

Conclusions

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