Risk Factors for Delayed Post-Polypectomy Bleeding

Min Jung Kwon; You Sun Kim; Song I Bae; Young Il Park; Kyung Jin Lee; Jung Hwa Min; Soo Yeon Jo; Mi Young Kim; Hye Jin Jung; Seong Yeon Jeong; Won Jae Yoon; Jin Nam Kim; Jeong Seop Moon

doi:10.5217/ir.2015.13.2.160

Articles

Page Path: HOME > Intest Res > Volume 13(2); 2015 > Article

Original Article Risk Factors for Delayed Post-Polypectomy Bleeding: Min Jung Kwon, You Sun Kim, Song I Bae, Young Il Park, Kyung Jin Lee, Jung Hwa Min, Soo Yeon Jo, Mi Young Kim, Hye Jin Jung, Seong Yeon Jeong, Won Jae Yoon, Jin Nam Kim, Jeong Seop Moon; Intestinal Research 2015;13(2):160-165.
DOI: https://doi.org/10.5217/ir.2015.13.2.160
Published online: April 27, 2015

Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Correspondence to You Sun Kim, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 9 Mareunnae-ro, Jung-gu, Seoul 100-032, Korea. Tel: +82-2-2270-0012, Fax: +82-2-2270-0257, yousunk69@korea.com

• Received: July 30, 2014 • Revised: December 13, 2014 • Accepted: January 12, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next

18,527 Views
82 Download
37 Web of Science
33 Crossref

Full Article

Download PDF

Abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
NOTES
REFERENCES

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.
Keywords: Colonoscopy; Polypectomy; Complication; Hemorrhage

INTRODUCTION

Colorectal cancer is the third and second most common cancer in men and women worldwide, respectively. In 2008, approximately 608,000 deaths from colorectal cancer were estimated worldwide, accounting for 8% of all cancer deaths, and making it the fourth most common cause of death from cancer.1 In Korea, the colorectal cancer incidence rates in 2008 were 54.7 and 36.9 per 100,000 individuals among men and women, respectively.2 A recent study showed an increase in the incidence of colon cancer among younger population and that more than one quarter (28.2%) of patients in South Korea were asymptomatic.3

Colonoscopic polypectomy for adenomas reduces the mortality rates of colorectal cancer.4,5,6 However, it is not completely free from complications. Bleeding is one of the most serious complications of endoscopic polypectomy, reported in approximately 1.0-6.1% of all cases.7,8,9

Bleeding can occur during the procedure (immediate post-polypectomy bleeding [PPB]) or after hospital discharge (delayed PPB). Several studies have demonstrated that the incidence of delayed PPB ranges from 0.4% to 1.1%.9,10,11,12,13,14,15 Clinically delayed PPB may be more serious because the volume of blood loss is more than that in immediate PPB, and appropriate treatment may be delayed.16 Therefore, delayed PPB is a serious complication that usually requires hospitalization, transfusion, and repeat endoscopy.

Several well-defined risk factors of delayed PPB include polyp size, shape, and location.7,13,14,17,18,19 However, few studies have examined less obvious risk factors. The aim of this study was to identify other factors associated with delayed PPB.

METHODS

1. Patients

We retrospectively reviewed the data from patients who underwent colonoscopic polypectomy at Seoul Paik Hospital, Inje University College of Medicine, between January 2003 and December 2012. Patients with IBD, non-epithelial neoplasms, or familial adenomatous polyposis were excluded from this study. In addition, patients with a bleeding tendency (e.g., ongoing anticoagulant or antiplatelet therapy, prothrombin time >30% of the normal range, or a platelet count <100×10³/mm³) and those with a history of colon surgery were also excluded. If anticoagulant or antiplatelet agents such as aspirin or ticlopidine had been prescribed, they were discontinued at least 7 days before the procedure. These patients restarted anticoagulant or antiplatelet agents 3-5 days after the procedure.20

Delayed PPB was defined as lower gastrointestinal bleeding that occurs between 24 hours and 14 days after the procedure.11 Patients who underwent polypectomy without delayed PPB were randomly selected among those who had been admitted during the polypectomy procedure. Patients who were age- and sex-matched were selected as a control group. The control-to-case ratio was 3:1.

The baseline characteristics of the patients and their polyps (tumor size, tumor location, tumor shape, and histopathological findings) were compared between the two groups. We also compared endoscopist experience (≥10 years' experience) and preventive prophylaxis between the groups. The primary goal of this study was to evaluate the risk factors of delayed PPB after colonoscopic polypectomy. This study was approved by the Institutional Review Board of Seoul Paik Hospital. A consent waiver was granted for this database study.

2. Procedures

Polypectomies were performed by using a standard flexible colonoscope (CFH260AL/CFH260AI; Olympus Optical Co., Tokyo, Japan). Snare polypectomy was most frequently used as either en bloc or piecemeal resection. Routine preinjection of the polyp base with saline was performed (Fig. 1A and 1B). An electrosurgical unit (VIO 300D; ERBE, Tübingen, Germany) was set according to the manufacturer's instructions, and mixed current was used at the time of resection. Delayed PPB was treated by transfusion, if needed, and endoscopic interventional procedures such as argon plasma coagulation or hemoclips to achieve hemostasis (Fig. 1C and 1D).

3. Statistical Analysis

Results of the comparisons of characteristics between cases and controls were analyzed by using the t-test for continuous variables and the chi-square test for categorical variables. All statistical analyses were performed by using the SPSS version 16 software (SPSS Inc., Chicago, IL, USA). Multivariate logistic regression analysis was conducted for the adjusted factors that affected delayed PPB. A P<0.05 was considered statistically significant.

RESULTS

1. Patients' Characteristics

Of the 1,745 patients who underwent colonoscopic polypectomy, 21 (1.2%) experienced delayed PPB. These patients were age- and sex-matched to 63 randomly selected control patients. The baseline characteristics of the case and control groups were similar. The male-to-female ratio and mean age did not differ between delayed PPB and control groups. The mean platelet count was 228.35±57.7 ×10³/mm³ in the bleeding group and 208.45±54.6 ×10³/mm³ in the control group (P=0.423). The mean international normalized ratio was 1.02±0.12 in the bleeding group and 0.99±0.07 in the control group (P=0.213). No significant differences were identified between the two groups of patients in terms of demographic characteristics, laboratory findings, and comorbidities such as hypertension, diabetes, cerebrovascular disease, and chronic liver disease (Table 1).

2. Risk Factors of Delayed PPB

By using the univariate logistic regression analysis, we found no significant differences in tumor histology, endoscopist experience, intubation time, or preventive prophylaxis such as hemoclip use and argon plasma coagulation between the case and control groups. However, significant differences in polyp size, shape, location, and patient's BMI were found between the two groups (Table 2).

The multivariate logistic regression analysis indicated that polyp size, shape, and location, and patient BMI were consistently associated with delayed PPB. Patients with polyps >10 mm had 2.6 times higher risk (95% CI, 1.035-4.528; P=0.049) than those with smaller polyps. In addition, patients with pedunculated polyps had 3.5 times higher risk (95% CI, 1.428-7.176; P=0.045) than those with sessile polyps. Patients with polyps located in the right hemicolon had 3.1 times higher risk (95% CI, 1.291-5.761; P=0.013) than those with polyps located in the left hemicolon. Patients with higher BMI had 3.7 times higher risk (95% CI, 1.876-8.613; P=0.013) than those with lower BMI (Table 3).

DISCUSSION

Many studies have reported that colonoscopic polypectomy reduces the incidence of colon cancer. It is well documented that most colonic adenocarcinomas arise from preexisting adenomatous colonic polyps.21,22

As a result of improvements in hemostatic instruments and techniques, hemorrhagic complications after colonoscopic polypectomies can be well controlled. However, PPB is still the most significant complication of endoscopic polypectomy.23,24,25,26,27

PPB is generally divided into 2 types, namely immediate bleeding after polypectomy and delayed bleeding that can occur up to 2 weeks after the procedure.7,11 Immediate bleeding following colonoscopic polypectomies can be easily detected and controlled, but delayed bleeding can have serious outcomes. In this study, delayed PPB was defined as lower gastrointestinal bleeding that occurred between 24 hours and 14 days after the procedure, because most cases of delayed PPB are reported during this period.11 In our study, the rate of delayed PPB is 1.2%, which is similar to that reported in a recent study.14

Previous studies have shown polyp size to be the most predictive factor of PPB. A retrospective cohort study showed that patients with polyps >10 mm had 4.5 times higher risk of PPB (95% CI, 2.0-10.3; P=0.003) than those with smaller polyps.18 Bae et al. also demonstrated that the risk of delayed PPB increased by 11.6% for every 1-mm increase in resected polyp diameter.13 Similarly, Sawhney et al. calculated a 9% increase in the risk of secondary PPB for every additional millimeter in polyp size.10 In our study, patients with polyps >10 mm also had 2.6 times higher risk (95% CI, 1.035-4.528; P=0.049) than those with smaller polyps. Although some studies yielded conflicting results, patients with sessile polyps have also been reported to be at increased risk of delayed PPB compared to patients with pedunculated ones. However, in our study, patients with pedunculated polyps had 3.5 times higher risk (95% CI, 1.428-7.176; P=0.045) than those with sessile polyps, which is not consistent with results from other studies.7,12,14,28 A recent study, however, has shown that protruding polyps (Ip, Isp) were associated with increased risk of delayed PPB,14 which is consistent with the results of our study. This observation could be associated with the blood vessels inside the stalk, which are exposed during the procedure. We assumed that the lower incidence of delayed PPB in patients with sessile polyps than in patients with pedunculated polyps could be attributable to more caution during procedures. As the procedures for pedunculated polyp removal are relatively simple compared with sessile polyps, the former may be performed, inadvertently, with less caution.

Polyp location is another factor of delayed PPB. A multicenter case-control study demonstrated that polyp localization to the right hemicolon is an independent risk factor of delayed PPB.29 Our study similarly showed that patients with polyps located in the right hemi-colon had 3.1 times higher risk (95% CI, 1.291-5.761; P=0.013) than those with polyps located in the left hemicolon. This risk may be associated with the thinner wall of the cecum, which increases vessel damage in the deeper submucosal layer.17 The histological properties of polyps were not significantly associated with delayed PPB, similar to the observation of another study.15

Of interest are the patients with BMI >25 kg/m² had 3.7 times higher risk (95% CI, 1.876-8.613; P=0.013) than those with BMI <25 kg/m². This finding of our study is quite unique; however, the biological mechanisms by which obesity increases the risk of PPB are unclear. We assumed that various adaptations and/or alterations in the cardiovascular system and its functioning may occur in obese individuals. These events might be modulated by substances (interleukin-6 and tumor necrosis factor-α) released from adipocytes, such as those in adipose tissue, that are excessively accumulated.15,30 More studies should be performed to analyze the association of obesity with delayed PPB.

This study has several limitations. This study was retrospective and based on existing medical records. In addition, the sample size was relatively small. Although the control group was randomly assigned, selection bias might have affected the validity of our study. For instance, interindividual variation in the techniques employed, which may play an important role in the incidence of delayed PPB, was not analyzed.

In conclusion, the incidence of delayed PPB was 1.2% in this study, and patients with large polyps, pedunculated polyps, or polyps located in the right hemicolon showed an increased risk of delayed PPB. In addition, patients with higher BMI also showed a higher risk of delayed PPB. Therefore, more caution is needed during polypectomies in patients with these risk factors.

NOTES

This work was supported by Research Grant of Inje University (2014).

Conflict of interest: None.

REFERENCES

1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893–2917.PMID: 21351269.Article PubMed
2. Lee BI, Hong SP, Kim SE, et al. Korean guidelines for colorectal cancer screening and polyp detection. Clin Endosc 2012;45:25–43.PMID: 22741131.Article PubMed PMC
3. Park SH, Song CW, Kim YB, et al. Clinicopathological characteristics of colon cancer diagnosed at primary health care institutions. Intest Res 2014;12:131–138.PMID: 25349580.Article PubMed PMC
4. 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.PMID: 8247072.Article PubMed
5. Manser CN, Bachmann LM, Brunner J, Hunold F, Bauerfeind P, Marbet UA. Colonoscopy screening markedly reduces the occurrence of colon carcinomas and carcinoma-related death: a closed cohort study. Gastrointest Endosc 2012;76:110–117.PMID: 22498179.Article PubMed
6. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366:687–696.PMID: 22356322.Article PubMed PMC
7. Rosen L, Bub DS, Reed JF 3rd, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum 1993;36:1126–1131.PMID: 8253009.Article PubMed
8. Dobrowolski S, Dobosz M, Babicki A, Glowacki J, Nalecz A. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc 2006;63:1004–1009.PMID: 16733117.Article PubMed
9. Kim HS, Kim KU, Park WK, et al. Delayed bleeding in a colonoscopic polypectomy: an experience with 5,236 polypectomies. J Korean Soc Coloproctol 2000;16:462–468.
10. Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy 2008;40:115–119.PMID: 18253906.Article PubMed
11. Singaram C, Torbey CF, Jacoby RF. Delayed postpolypectomy bleeding. Am J Gastroenterol 1995;90:146–147.PMID: 7801918.PubMed
12. Kim DH, Lim SW. Analysis of delayed postpolypectomy bleeding in a colorectal clinic. J Korean Soc Coloproctol 2011;27:13–16.PMID: 21431091.Article PubMed PMC
13. Bae GH, Jung JT, Kwon JG, et al. Risk factors of delayed bleeding after colonoscopic polypectomy: case-control study. Korean J Gastroenterol 2012;59:423–427.PMID: 22735875.Article PubMed
14. 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.PMID: 24231934.Article PubMed
15. Wu XR, Church JM, Jarrar A, Liang J, Kalady MF. Risk factors for delayed postpolypectomy bleeding: how to minimize your patients' risk. Int J Colorectal Dis 2013;28:1127–1134.PMID: 23440363.Article PubMed
16. Waye JD, Lewis BS, Yessayan S. Colonoscopy: a prospective report of complications. J Clin Gastroenterol 1992;15:347–351.PMID: 1294644.Article PubMed
17. Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 2000;51:690–696.PMID: 10840301.Article PubMed
18. 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.PMID: 16813806.Article PubMed
19. Bourke MJ. Bleeding following wide-field endoscopic resection in the colon. Gastroenterol Hepatol (N Y) 2011;7:814–817.PMID: 22347820.PubMed PMC
20. Pan A, Schlup M, Lubcke R, Chou A, Schultz M. The role of aspirin in post-polypectomy bleeding-a retrospective survey. BMC Gastroenterol 2012;12:138PMID: 23046845.Article PubMed PMC PDF
21. Jass JR. Do all colorectal carcinomas arise in preexisting adenomas? World J Surg 1989;13:45–51.PMID: 2658353.Article PubMed
22. Morson B. President's address. The polyp-cancer sequence in the large bowel. Proc R Soc Med 1974;67:451–457.PMID: 4853754.PubMed PMC
23. Hachisu T. A new detachable snare for hemostasis in the removal of large polyps or other elevated lesions. Surg Endosc 1991;5:70–74.PMID: 1948617.Article PubMed
24. Pontecorvo C, Pesce G. The 'safety snare'-a ligature-placing snare to prevent haemorrhage after transection of large pedunculated polyps. Endoscopy 1986;18:55–56.PMID: 3956439.Article PubMed PDF
25. Binmoeller KF, Thonke F, Soehendra N. Endoscopic hemoclip treatment for gastrointestinal bleeding. Endoscopy 1993;25:167–170.PMID: 8491134.Article PubMed PDF
26. Hachisu T. Evaluation of endoscopic hemostasis using an improved clipping apparatus. Surg Endosc 1988;2:13–17.PMID: 3051463.Article PubMed
27. Parra-Blanco A, Kaminaga N, Kojima T, et al. Hemoclipping for postpolypectomy and postbiopsy colonic bleeding. Gastrointest Endosc 2000;51:37–41.PMID: 10625793.Article PubMed
28. Heldwein W, Dollhopf M, Rosch 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.PMID: 16281142.Article PubMed PDF
29. 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.PMID: 21266961.Article PubMed PDF
30. Shoelson SE, Herrero L, Naaz A. Obesity, inflammation, and insulin resistance. Gastroenterology 2007;132:2169–2180.PMID: 17498510.Article PubMed

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.

Table 1

Baseline Characteristics of the Case and Control Groups

Values are presented as mean±SD or n (%).

^*Hypertension, diabetes, cerebrovascular disease, and chronic liver disease.

INR, international normalized ratio; aPTT, activated partial thromboplastin time.

Table 2

Univariate Analysis of Risk Factors of Delayed Post-Polypectomy Bleeding

Values are presented as n (%).

^*Includes the descending colon, sigmoid colon, and rectum.

^†Includes the cecum, ascending colon, and transverse colon.

Table 3

Multivariate Analysis of Risk Factors Associated With Delayed Post-Polypectomy Bleeding

^*Includes the descending colon, sigmoid colon, and rectum.

^†Includes the cecum, ascending colon, and transverse colon.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

The Use of Clips to Prevent Post-Polypectomy Bleeding: A Clinical Review
Matthew A. O’Mara, Peter G. Emanuel, Aaron Tabibzadeh, Robert J. Duve, Jonathan S. Galati, Gregory Laynor, Samantha Gross, Seth A. Gross
Journal of Clinical Gastroenterology.2024; 58(8): 739. CrossRef
Is endoscopic hemostasis safe and effective for delayed post-polypectomy bleeding?
Jae-Yong Cho, Yunho Jung, Han Hee Lee, Jung-Wook Kim, Kee Myung Lee, Hyun Lim, Geun-Hyuk Choi, Seong Woo Choi, Bo-In Lee
International Journal of Gastrointestinal Intervention.2024; 13(4): 122. CrossRef
Colonic polypectomy in 2024: hot or cold?
K Ferdinande, L Desomer, D De Looze, D.J. Tate
Acta Gastro Enterologica Belgica.2024; 87(4): 505. CrossRef
Cost-Effectiveness of Earlier or More Intensive Colorectal Cancer Screening in Overweight and Obese Patients
Aaron Yeoh, Ajitha Mannalithara, Uri Ladabaum
Clinical Gastroenterology and Hepatology.2023; 21(2): 507. CrossRef
Prophylactic clipping to prevent delayed colonic post-polypectomy bleeding: meta-analysis of randomized and observational studies
Kirles Bishay, Zhao Wu Meng, Levi Frehlich, Matthew T. James, Gilaad G. Kaplan, Michael J. Bourke, Robert J. Hilsden, Steven J. Heitman, Nauzer Forbes
Surgical Endoscopy.2022; 36(2): 1251. CrossRef
Establishment of a model for predicting delayed post-polypectomy bleeding: A real-world retrospective study
Yu Lu, Xiaoying Zhou, Han Chen, Chao Ding, Xinmin Si
Frontiers in Medicine.2022;[Epub] CrossRef
Blood group O is a risk factor for delayed post-polypectomy bleeding
Hiroto Furuhashi, Akira Dobashi, Naoto Tamai, Nana Shimamoto, Masakuni Kobayashi, Shingo Ono, Yuko Hara, Hiroaki Matsui, Shunsuke Kamba, Hideka Horiuchi, Akio Koizumi, Tomohiko R. Ohya, Masayuki Kato, Keiichi Ikeda, Hiroshi Arakawa, Kazuki Sumiyama
Surgical Endoscopy.2021; 35(12): 6882. CrossRef
Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection
Takuya Okugawa, Tadayuki Oshima, Keisuke Nakai, Hirotsugu Eda, Akio Tamura, Ken Hara, Tomohiro Ogawa, Tomoaki Kono, Takashi Kondo, Katsuyuki Tozawa, Masashi Fukushima, Toshihiko Tomita, Hirokazu Fukui, Jiro Watari, Hiroto Miwa
Journal of Clinical Medicine.2021; 10(5): 928. CrossRef
Endoscopic characteristics influencing postpolypectomy bleeding in 1147 consecutive pedunculated colonic polyps: a multicenter retrospective study
Teppei Tagawa, Masayoshi Yamada, Takeyoshi Minagawa, Masanori Sekiguchi, Kenichi Konda, Hirohito Tanaka, Hiroyuki Takamaru, Masau Sekiguchi, Taku Sakamoto, Takahisa Matsuda, Aya Kuchiba, Hitoshi Yoshida, Yutaka Saito
Gastrointestinal Endoscopy.2021; 94(4): 803. CrossRef
Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients
Oliver Bendall, Joel James, Katarzyna M Pawlak, Sauid Ishaq, J Andy Tau, Noriko Suzuki, Steven Bollipo, Keith Siau
Clinical and Experimental Gastroenterology.2021; Volume 14: 477. CrossRef
Prevention of delayed post-polypectomy bleeding: Should we amend the 2017 ESGE Guideline?
Alexandra Mack, Dileep Mangira, Alan Moss
Endoscopy International Open.2020; 08(09): E1111. CrossRef
Prophylactic hemoclips in prevention of delayed post-polypectomy bleeding for ≥ 1 cm colorectal polyps: meta-analysis of randomized controlled trials
Faisal Kamal, Muhammad A. Khan, Salman Khan, Hemnishil K. Marella, Tamara Nelson, Zubair Khan, Dina Ahmad, Claudio Tombazzi, Mohammad K. Ismail, Colin W. Howden
Endoscopy International Open.2020; 08(09): E1102. CrossRef
Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy
Hosim Soh, Jaeyoung Chun, Seung Wook Hong, Seona Park, Yun Bin Lee, Hyun Jung Lee, Eun Ju Cho, Jeong-Hoon Lee, Su Jong Yu, Jong Pil Im, Yoon Jun Kim, Joo Sung Kim, Jung-Hwan Yoon
Gut and Liver.2020; 14(6): 755. CrossRef
Risk factors for delayed hemorrhage after colonoscopic postpolypectomy: Polyp size and operative modality
Changqin Liu, Ruijin Wu, Xiaomin Sun, Chunhua Tao, Zhanju Liu
JGH Open.2019; 3(1): 61. CrossRef
Risk factors for severe complications of colonoscopy in screening programs
Mercedes Vanaclocha-Espi, Josefa Ibáñez, Ana Molina-Barceló, María José Valverde-Roig, Elena Pérez, Andreu Nolasco, Mariola de la Vega, Isabel Diez de la Lastra-Bosch, María Elena Oceja, Josep Alfons Espinàs, Rebeca Font, Francisco Pérez-Riquelme, Eunate
Preventive Medicine.2019; 118: 304. CrossRef
Adverse events related to colonoscopy: Global trends and future challenges
Su Young Kim, Hyun-Soo Kim, Hong Jun Park
World Journal of Gastroenterology.2019; 25(2): 190. CrossRef
Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection
A. S. Turan, G. Ultee, E. J. M. Van Geenen, P. D. Siersema
Expert Review of Medical Devices.2019; 16(6): 493. CrossRef
Prospective analysis of delayed colorectal post-polypectomy bleeding
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
Surgical Endoscopy.2018; 32(7): 3282. CrossRef
Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice
Moon Joo Hwang, Kyeong Ok Kim, A Lim Kim, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim
Intestinal Research.2018; 16(3): 475. CrossRef
Screening colonoscopy and risk of adverse events among individuals undergoing fecal immunochemical testing in a population‐based program: A nested case‐control study
Eunate Arana-Arri, Natale Imaz-Ayo, Mari Jose Fernández, Isabel Idigoras, Isabel Bilbao, Luis Bujanda, Fidencio Bao, Enrique Ojembarrena, Ines Gil, Iñaki Gutiérrez-Ibarluzea, Isabel Portillo
United European Gastroenterology Journal.2018; 6(5): 755. CrossRef
Evaluation and management of lower gastrointestinal bleeding
Aun Raza Shah, Vikram Jala, Hammad Arshad, Mohammad Bilal
Disease-a-Month.2018; 64(7): 321. CrossRef
Endoscopic treatment of surgery or procedure-related gastrointestinal bleeding
Ki Bae Bang, Hyun Deok Shin
International Journal of Gastrointestinal Intervention.2018; 7(3): 112. CrossRef
Risk factors for delayed colonic post-polypectomy bleeding: a systematic review and meta-analysis
Veeravich Jaruvongvanich, Narut Prasitlumkum, Buravej Assavapongpaiboon, Sakolwan Suchartlikitwong, Anawin Sanguankeo, Sikarin Upala
International Journal of Colorectal Disease.2017; 32(10): 1399. CrossRef
Association between the ulcer status and the risk of delayed bleeding after the endoscopic mucosal resection of colon
Gwang‐Un Kim, Myeongsook Seo, Eun Mi Song, Sung Wook Hwang, Sang Hyoung Park, Dong‐Hoon Yang, Jeong‐Sik Byeon
Journal of Gastroenterology and Hepatology.2017; 32(11): 1846. CrossRef
Clinical outcome of endoscopic management in delayed postpolypectomy bleeding
Jeong-Mi Lee, Wan Soo Kim, Min Seob Kwak, Sung-Wook Hwang, Dong-Hoon Yang, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
Intestinal Research.2017; 15(2): 221. CrossRef
Are Hemorrhoids Associated with False-Positive Fecal Immunochemical Test Results?
Nam Hee Kim, Jung Ho Park, Dong Il Park, Chong Il Sohn, Kyuyong Choi, Yoon Suk Jung
Yonsei Medical Journal.2017; 58(1): 150. CrossRef
Prediction and Prevention of Postpolypectomy Bleeding: Necessity of a Different Approach for Patients Using Antithrombotic Agents
Duk Hwan Kim
Clinical Endoscopy.2017; 50(3): 217. CrossRef
Serum CEA and CA 19-9 Levels are Associated with the Presence and Severity of Colorectal Neoplasia
Nam Hee Kim, Mi Yeon Lee, Jung Ho Park, Dong Il Park, Chong Il Sohn, Kyuyong Choi, Yoon Suk Jung
Yonsei Medical Journal.2017; 58(5): 918. CrossRef
A Quality Improvement Educational Intervention to Increase Knowledge of Cardiogastroenterology Amongst Medical Trainees and Nursing Staff
Elena Fradkov, Alexander Goldowsky, Kirsten Quiles, Renee Williams
MedEdPORTAL.2017;[Epub] CrossRef
New Quality Measure Will Disincentivize Endoscopic Resection of Most Important Colorectal Lesions
Douglas K. Rex, Thomas F. Imperiale
Gastroenterology.2016; 150(5): 1249. CrossRef
A new quality indicator of colonoscopy: caveat emptor
Thomas F. Imperiale, Douglas K. Rex
Gastrointestinal Endoscopy.2016; 84(3): 507. CrossRef
Anesthetist-Directed Sedation for Colonoscopy: A Safe Haven or Siren’s Song?
Douglas K. Rex, John J. Vargo
Gastroenterology.2016; 150(4): 801. CrossRef
Complication de la coloscopie
D. Heresbach
EMC - Gastro-entérologie.2016; 33(4): 1. CrossRef

PubReader

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Risk Factors for Delayed Post-Polypectomy Bleeding

Intest Res. 2015;13(2):160-165. Published online April 27, 2015

DOI: https://doi.org/10.5217/ir.2015.13.2.160

XML Download

Figure

Risk Factors for Delayed Post-Polypectomy Bleeding

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.

Fig. 1

Risk Factors for Delayed Post-Polypectomy Bleeding

Table 1

Baseline Characteristics of the Case and Control Groups

Values are presented as mean±SD or n (%).

^*Hypertension, diabetes, cerebrovascular disease, and chronic liver disease.

INR, international normalized ratio; aPTT, activated partial thromboplastin time.

Table 2

Univariate Analysis of Risk Factors of Delayed Post-Polypectomy Bleeding

Values are presented as n (%).

^*Includes the descending colon, sigmoid colon, and rectum.

^†Includes the cecum, ascending colon, and transverse colon.

Table 3

Multivariate Analysis of Risk Factors Associated With Delayed Post-Polypectomy Bleeding

^*Includes the descending colon, sigmoid colon, and rectum.

^†Includes the cecum, ascending colon, and transverse colon.

Table 1 Baseline Characteristics of the Case and Control Groups

Values are presented as mean±SD or n (%).

^*Hypertension, diabetes, cerebrovascular disease, and chronic liver disease.

INR, international normalized ratio; aPTT, activated partial thromboplastin time.

Table 2 Univariate Analysis of Risk Factors of Delayed Post-Polypectomy Bleeding

Values are presented as n (%).

^*Includes the descending colon, sigmoid colon, and rectum.

^†Includes the cecum, ascending colon, and transverse colon.

Table 3 Multivariate Analysis of Risk Factors Associated With Delayed Post-Polypectomy Bleeding