Journal List > Korean J Gastroenterol > v.59(6) > 1006965

TOOLS
Bae, Jung, Kwon, Kim, Park, Seo, and Kim: Risk Factors of Delayed Bleeding after Colonoscopic Polypectomy: Case-Control Study
Original Article
Alimentary Tract
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(6): 423-427.

Published online: 20 June 2012

DOI: https://doi.org/10.4166/kjg.2012.59.6.423

Risk Factors of Delayed Bleeding after Colonoscopic Polypectomy: Case-Control Study

Gyu Hwan Bae, Jin Tae Jung, Joong Gu Kwon, Eun Young Kim, Jin Hong Park, Jung Hyun Seo, Jong Yeon Kim1

Department of Internal Medicine, Catholic University of Daegu College of Medicine, Daegu, Korea.

1Department of Preventive Medicine, Catholic University of Daegu College of Medicine, Daegu, Korea.

Correspondence to: Jin Tae Jung, Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Medical Center, 33, Dooryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea. Tel: +82-53-650-4217, Fax: +82-53-628-4005, jungjt@cu.ac.kr

Received 23 September 2011       Revised 27 November 2011       Accepted 27 November 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

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.

Abstract

Background/Aims

Colonoscopic polypectomy is a valuable procedure for preventing colorectal cancer, but is not without complications. Delayed bleeding after colonoscopic polypectomy is a rare, but serious complication. The aim of this study was to identify risk factors of delayed bleeding after colonoscopic polypectomy.

Methods

A retrospective case-control study was conducted in a single university hospital. Forty cases and 120 controls were included. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, endoscopist's experience, resection method, use of sedation, and use of prophylactic hemostasis.

Results

In univariate analysis, size, histology and number of resected polyps, endoscopist's experience, resection method and use of prophylactic hemostasis were significant risk factors for delayed bleeding after colonoscopic polypectomy. In multivariate analysis, risk of delayed bleeding increased by 11.6% for every 1 mm increase in resected polyp diameter (OR, 1.116; 95% CI 1.041-1.198; p=0.002). Number of resected polyps (OR, 1.364; 95% CI, 1.113-1.671; p=0.003) and endoscopist's experience (OR, 6.301; 95% CI, 2.022-19.637; p=0.002) were significant risk factors for delayed bleeding after colonoscopic polypectomy.

Conclusions

Size and numbers of resected polyps, and endoscopist's experience were independent risk factors for delayed bleeding after colonoscopic polypectomy. More caution would be necessary when removing polyps with these factors.

Keywords: Bleeding, Polypectomy, Colonoscopy, Complication

Figures and Tables

Table 1
Baseline Characteristics of Patients-Control Group
kjg-59-423-i001

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

Table 2
Patients Related Factors for Delayed Bleeding after Colonoscopic Polypectomy
kjg-59-423-i002

Values are presented as n (%).

CVA, cerebrovascular accident.

Table 3
Polyp Related Factors for Delayed Bleeding after Colonoscopic Polypectomy
kjg-59-423-i003

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

Table 4
Multivariate Analysis of Risk Factors for Delayed Bleeding after Colonoscopic Polypectomy
kjg-59-423-i004
Table 5
Procedure Related Factors for Delayed Bleeding of Colonoscopic Polypectomy
kjg-59-423-i005

Values are presented as n (%).

EMR-P, endoscopic mucosal resection-precutting.

Notes

Financial support: None.

Conflict of interest: None.

References

1. Anually incidence, crude incidence rate, and age-standardized incidence rate of major cancer in Korea [Internet]. 2010. cited 2011 Aug 15. Goyang (Korea): National Cancer Information Center;Available from: www.cancer.go.kr.
2. 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.
3. Kim YS, Lee DS, Jung JJ, et al. Complication of colonoscopic polypectomy. Korean J Gastrointest Endosc. 2000. 21:917–923.
4. Heldwein W, Dollhopf M, Rösch 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.
5. Rathgaber SW, Wick TM. Colonoscopy completion and complication rates in a community gastroenterology practice. Gastrointest Endosc. 2006. 64:556–562.
6. Kim DH, Lim SW. Analysis of delayed postpolypectomy bleeding in a colorectal clinic. J Korean Soc Coloproctol. 2011. 27:13–16.
7. 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.
8. 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.
9. Macrae FA, Tan KG, Williams CB. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies. Gut. 1983. 24:376–383.
10. Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy. 2008. 40:115–119.
11. 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.
12. Fatima H, Rex DK. Minimizing endoscopic complications: colonoscopic polypectomy. Gastrointest Endosc Clin N Am. 2007. 17:145–156.
13. Rosen L, Bub DS, Reed JF 3rd, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum. 1993. 36:1126–1131.
14. Baillie J. Postpolypectomy bleeding. Am J Gastroenterol. 2007. 102:1151–1153.
15. Lee CK, Lee SH, Park JY, et al. Prophylactic argon plasma coagulation ablation does not decrease delayed postpolypectomy bleeding. Gastrointest Endosc. 2009. 70:353–361.
16. Shioji K, Suzuki Y, Kobayashi M, et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2003. 57:691–694.
17. Church JM. Experience in the endoscopic management of large colonic polyps. ANZ J Surg. 2003. 73:988–995.
18. Cipolletta L, Bianco MA, Rotondano G, Catalano M, Prisco A, De ST. Endoclip-assisted resection of large pedunculated colon polyps. Gastrointest Endosc. 1999. 50:405–406.
19. 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.
20. Yousfi M, Gostout CJ, Baron TH, et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol. 2004. 99:1785–1789.
21. Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc. 2000. 51:690–696.
TOOLS
Similar articles