Clin Endosc.  2017 May;50(3):287-292. 10.5946/ce.2016.126.

Colonic Postpolypectomy Bleeding Is Related to Polyp Size and Heparin Use

Affiliations
  • 1Digestive Endoscopic Unit, New Civil Hospital S. Agostino Estense, Baggiovara, Vignola Hospital, Vignola, Modena, Italy. flaviapigo@virgilio.it
  • 2Internal Medicine Department, Vignola Hospital, Vignola, Modena, Italy.

Abstract

BACKGROUND/AIMS
We studied factors influencing colon postpolypectomy bleeding (PPB), with a focus on antithrombotic and anticoagulation therapy.
METHODS
We conducted a retrospective case-control study of all patients who underwent polypectomy at our tertiary referral center in Italy between 2007 and 2014. Polyp characteristics (number of polyps removed per patient, size, morphology, location, resection technique, prophylactic hemostasis methods) and patient characteristics (age, sex, comorbidities, medication) were analyzed.
RESULTS
The case and control groups included 118 and 539 patients, respectively. The two groups differed in the frequency of comorbidities (69% vs. 40%, p=0.001), polyps removed (27% vs. 18%, p=0.02), and use of heparin therapy (23% vs. 1%, p<0.001). A total of 279 polyps in the case group and 966 in the control group were nonpedunculated (69% vs. 81%, p=0.01) and measured ≥10 mm (78% vs. 32%, p=0.001). Multivariate analysis showed that polyps ≥10 mm (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.3-15.5), administration of heparin (OR, 16.5; 95% CI, 6.2-44), comorbidity (OR, 2.3; 95% CI, 1.4-3.9), and presence of ≥2 risk factors (OR, 3.2; 95% CI, 1.7-6.0) were associated with PPB.
CONCLUSIONS
The incidence of PPB increases with polyp size ≥10 mm, heparin use, comorbidity, and presence of ≥2 risk factors.

Keyword

Postpolypectomy bleeding; Colonoscopy; Hemorrhage; Humans

MeSH Terms

Case-Control Studies
Colon*
Colonoscopy
Comorbidity
Hemorrhage*
Hemostasis
Heparin*
Humans
Incidence
Italy
Multivariate Analysis
Polyps*
Retrospective Studies
Risk Factors
Tertiary Care Centers
Heparin

Cited by  1 articles

Prediction and Prevention of Postpolypectomy Bleeding: Necessity of a Different Approach for Patients Using Antithrombotic Agents
Duk Hwan Kim
Clin Endosc. 2017;50(3):217-218.    doi: 10.5946/ce.2017.056.


Reference

1. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993; 329:1977–1981.
2. Wexner SD, Garbus JE, Singh JJ. A prospective analysis of 13,580 colonoscopies. Reevaluation of credentialing guidelines. Surg Endosc. 2001; 15:251–261.
3. Bowles CJ, Leicester R, Romaya C, Swarbrick E, Williams CB, Epstein O. A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow? Gut. 2004; 53:277–283.
Article
4. Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists. Gastrointest Endosc. 2001; 53:620–627.
Article
5. Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy. 2008; 40:115–119.
Article
6. Amato A, Radaelli F, Dinelli M, et al. Early and delayed complications of polypectomy in a community setting: The SPoC prospective multicentre trial. Dig Liver Dis. 2016; 48:43–48.
Article
7. Zhang Q, An S, Chen Z, et al. Assessment of risk factors for delayed colonic post-polypectomy hemorrhage: a study of 15553 polypectomies from 2005 to 2013. PLoS One. 2014; 9:e108290.
Article
8. Kim HH, Kim SE, Cho EJ. What can be the criteria of outpatient-based endoscopic resection for colon polyp? World J Gastrointest Endosc. 2014; 6:493–498.
Article
9. Choung BS, Kim SH, Ahn DS, et al. Incidence and risk factors of delayed postpolypectomy bleeding: a retrospective cohort study. J Clin Gastroenterol. 2014; 48:784–789.
10. Manocha D, Singh M, Mehta N, Murthy UK. Bleeding risk after invasive procedures in aspirin/NSAID users: polypectomy study in veterans. Am J Med. 2012; 125:1222–1227.
Article
11. Gimeno-Garcia AZ, de Ganzo ZA, Sosa AJ, Perez DN, Quintero E. Incidence and predictors of postpolypectomy bleeding in colorectal polyps larger than 10 mm. Eur J Gastroenterol Hepatol. 2012; 24:520–526.
12. 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.
Article
13. Veitch AM, Vanbiervliet G, Gershlick AH, et al. 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. 2016; 48:385–402.
Article
14. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012; 141(Suppl 2):e326S–e350S.
15. Schulman S, Angerås U, Bergqvist D, Eriksson B, Lassen MR, Fisher W. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost. 2010; 8:202–204.
Article
16. Participants in the Paris workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. Gastrointest Endosc. 2003; 58(Suppl 6):S3–S43.
17. Shiffman ML, Farrel MT, Yee YS. Risk of bleeding after endoscopic biopsy or polypectomy in patients taking aspirin or other NSAIDS. Gastrointest Endosc. 1994; 40:458–462.
Article
18. Yousfi M, Gostout CJ, Baron TH, et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol. 2004; 99:1785–1789.
Article
19. Pan A, Schlup M, Lubcke R, Chou A, Schultz M. The role of aspirin in post-polypectomy bleeding--a retrospective survey. BMC Gastroenterol. 2012; 12:138.
Article
20. Metz AJ, Bourke MJ, Moss A, Williams SJ, Swan MP, Byth K. Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions. Endoscopy. 2011; 43:506–511.
Article
21. Gandhi S, Narula N, Mosleh W, Marshall JK, Farkouh M. Meta-analysis: colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy. Aliment Pharmacol Ther. 2013; 37:947–952.
Article
22. Inoue T, Nishida T, Maekawa A, et al. Clinical features of post-polypectomy bleeding associated with heparin bridge therapy. Dig Endosc. 2014; 26:243–249.
Article
23. Witt DM, Delate T, McCool KH, et al. Incidence and predictors of bleeding or thrombosis after polypectomy in patients receiving and not receiving anticoagulation therapy. J Thromb Haemost. 2009; 7:1982–1989.
Article
24. Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015; 373:823–833.
Article
25. Canadian Institutes of Health Research (CIHR). PERIOP 2 - A safety and effectiveness study of LMWH bridging therapy versus placebo bridging therapy for patients on long term warfarin and require temporary interruption of their warfarin [Internet]. Bethesda: ClinicalTrials.gov;c2016. [updated 2016 Mar 2; cited 2016 Dec 28]. Available from: https://clinicaltrials.gov/ct2/show/NCT00432796.
26. Olesen JB, Lip GY, Hansen ML, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011; 342:d124.
Article
27. Katsinelos P, Fasoulas K, Chatzimavroudis G, et al. Prophylactic clip application before endoscopic resection of large pedunculated colorectal polyps in patients receiving anticoagulation or antiplatelet medications. Surg Laparosc Endosc Percutan Tech. 2012; 22:e254–e258.
Article
28. 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.
Article
29. Corte CJ, Burger DC, Horgan G, Bailey AA, East JE. Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasis or epinephrine: a meta-analysis. United European Gastroenterol J. 2014; 2:123–130.
Article
30. Parikh ND, Zanocco K, Keswani RN, Gawron AJ. A cost-efficacy decision analysis of prophylactic clip placement after endoscopic removal of large polyps. Clin Gastroenterol Hepatol. 2013; 11:1319–1324.
Article
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