Intest Res.  2015 Apr;13(2):160-165. 10.5217/ir.2015.13.2.160.

Risk Factors for Delayed Post-Polypectomy Bleeding

• 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

• KMID: 2284883
• DOI: http://doi.org/10.5217/ir.2015.13.2.160

Abstract

BACKGROUND/AIMS
Among the many complications that can occur following therapeutic endoscopy, bleeding is the most serious, which occurs in 1.0-6.1% of all colonoscopic polypectomies. The aim of this study was to identify risk factors of delayed post-polypectomy bleeding (PPB).
METHODS
We retrospectively reviewed the data of patients who underwent colonoscopic polypectomy between January 2003 and December 2012. We compared patients who experienced delayed PPB with those who did not. The control-to-patient ratio was 3:1. The clinical data analyzed included polyp size, number, location, and shape, patient' body mass index (BMI), preventive hemostasis, and endoscopist experience.
RESULTS
Of 1,745 patients undergoing colonoscopic polypectomy, 21 (1.2%) experienced significant delayed PPB. We selected 63 age- and sex-matched controls. Multivariate logistic regression analysis showed that polyps >10 mm (odds ratio [OR], 2.605; 95% confidence interval [CI], 1.035-4.528; P=0.049), a pedunculated polyp (OR, 3.517; 95% CI, 1.428-7.176; P=0.045), a polyp located in the right hemicolon (OR, 3.10; 95% CI, 1.291-5.761; P=0.013), and a high BMI (OR, 3.681; 95% CI, 1.876-8.613; P=0.013) were significantly associated with delayed PPB.
CONCLUSIONS
Although delayed PPB is a rare event, more caution is needed during colonoscopic polypectomies performed in patients with high BMI or large polyps, pedunculated polyps, or polyps located in the right hemicolon.

Keyword

Colonoscopy; Polypectomy; Complication; Hemorrhage

MeSH Terms

Body Mass Index
Colonoscopy
Endoscopy
Hemorrhage*
Hemostasis
Humans
Logistic Models
Polyps
Retrospective Studies
Risk Factors*

Figure

• 

  Fig. 1 (A) Colon polypectomy. Snare closed at the base of the polyp. (B) Base of the polyp after polypectomy. No immediate bleeding occurred. (C) Delayed post-polypectomy bleeding. Three days later, the patient complained of hematochezia, and fresh blood and clots were observed on endoscopy. (D) Endoscopic treatment. Endoscopic clipping for the treatment of delayed post-polypectomy bleeding was performed.

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