Early and delayed complications of polypectomy in a community setting: The SPoC prospective multicentre trial

Amato, Arnaldo; Radaelli, Franco; Dinelli, M.; Crosta, C.; Cengia, Gianpaolo; Beretta, P; Devani, Massimo; Lochis, Davide; Manes, G.; Fini, Lucia; Paggi, Silvia; Passoni, G. Rubis; Repici, Alessandro; Redaelli, A.; Cestari, Renzo; Prada, Alberto; Bernasconi, Giordano; Pallotta, S.; Gebbia, C.; Cambareri, A. R.; Rovedatti, L.; Perego, M.; Viganò, Chiara; Zappa, Marco Antonio; Bargiggia, S.; Parente, F.; Spinzi, Giancarlo; Leoci, Claudio; Piubello, W.; Grillo, S.

doi:10.1016/j.dld.2015.09.007

Cited by 18 publications

(20 citation statements)

References 35 publications

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“…On the other hand, overall adverse events in our study were substantially lower as compared with another Italian community-based study [13], which reported 1.4% major adverse events after polypectomy, over 2-fold higher than our findings. This may reflect the higher expertise of the endoscopists involved in a screening program as compared to community-based endoscopists, but could also be a proxy of the reduced reporting of adverse events in an organized screening program.…”

Section: Discussioncontrasting

confidence: 96%

Colonoscopy-related adverse events and mortality in an Italian organized colorectal cancer screening program

Benazzato¹,

Zorzi

Antonelli

et al. 2020

Endoscopy

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Background and Aims Post-colonoscopy adverse events (AE) are a key quality indicator in population-based colorectal cancer screening programs, affecting safety and costs. Aim of this study was to assess colonoscopy-related AE and mortality in a screening setting. Methods We retrieved data from a cohort of patients undergoing colonoscopy within a screening program (Faecal Immunochemical Test every 2 years, 50 to 69 years old, or post-polypectomy surveillance) in Italy between 2002 and 2014, to assess the rate of post-colonoscopy related AE and mortality. Any admission within 30 days of a screening colonoscopy was reviewed to capture any possible AE. Mortality registries were also matched with endoscopy database to investigate 30-day post colonoscopy mortality rate. Association of each outcome with patient/procedure related variables was assessed with multivariable analysis. Results Overall, 117,881 screening colonoscopies (66,584, 56.5%, with polypectomy) were included. Overall, 497/117,881 (0.42%) post-colonoscopy AE occurred: 281 (0.24%) bleedings and 65 (0.05%) perforations (3.7‰/0.7‰, operative/diagnostic procedures, p<0.001). At multivariable analysis, bleeding was associated to polyp size (≥20mm: OR 16.29, 95%CI: 9.39-28.29), proximal location (OR 1.46, 95%CI: 1.14-1.87), and histology severity (high-risk adenoma, OR 5.6, 95%CI: 2.43-12.91), while perforation was associated to endoscopic resection (OR 2.91, 95%CI: 1.62-5.22), polyp size (OR 4.34, 95%CI: 1.46-12.92) and proximal location (OR 1.94, 95%CI: 1.12-3.37). Post-colonoscopy death occurred in 15/117,881 (1.27x10,000) cases. Conclusions In an organised screening program, post-colonoscopy AE are a rare but not negligible eventuality. The most frequent is post-polypectomy bleeding, especially after resection of large (≥20mm) and proximal lesions.

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Section: Discussioncontrasting

confidence: 96%

Colonoscopy-related adverse events and mortality in an Italian organized colorectal cancer screening program

Benazzato¹,

Zorzi

Antonelli

et al. 2020

Endoscopy

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“…In fact, polyps in the cecum showed more morbidity than those on the left side of the colon. [5][6][7] This point reinforces the usefulness of endoscopic clip closure after polyp resection. Second, patients were hospitalized 1 day before the procedure, and the length of the hospital stay was 3.1 days in the "clip closing" group.…”

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confidence: 54%

Clipping after large colorectal polyp resections reduces adverse events and allows ambulatory management

Dior

Dréanic

Prat

et al. 2016

Gastrointestinal Endoscopy

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We read with great interest the article by Zhang et al 1 accompanied by an editorial. 2 The development of large polyp endoscopic resection over the past few years has allowed a reduction in rescue surgery and reduced the morbidity and mortality rates. In a randomized study, Zhang et al identified that clip closure after large polyp resections decreased adverse events such as postprocedure bleeding, postpolypectomy coagulation syndrome, and abdominal pain. 1 This study is in line with previous studies and has raised some comments on endoscopy management. 3,4 First, the localization of the polyps appeared of interest, and it should have been identified. In fact, polyps in the cecum showed more morbidity than those on the left side of the colon. [5][6][7] This point reinforces the usefulness of endoscopic clip closure after polyp resection. Second, patients were hospitalized 1 day before the procedure, and the length of the hospital stay was 3.1 days in the "clip closing" group. We previously showed that in colorectal lesions larger than 20 mm in diameter, the risk of adverse events from the endoscopic procedure is low, and ambulatory management for EMR is feasible. 3 We demonstrated that closing the lesion with at least 1 clip per centimeter reduced the rate of adverse events sufficiently to allow outpatient treatment.When these points are taken into consideration, clip closure of mucosal defects and ambulatory management appear to offer high-quality, safe, and cost-effective treatment of patients undergoing large polyp resection. DISCLOSUREAll authors disclosed no financial relationships relevant to this publication.

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“…In our cohort, we found a fairly high rate of immediate bleeding (14%) compared to colonic polypectomy [23,24] with classic bleeding rates below 5%. This fact is most likely due to the abundant vascularization of the duodenal mucosa.…”

Section: Discussionmentioning

confidence: 82%

Nonampullary Duodenal Adenomas Rarely Recur after Complete Endoscopic Resection: A Swiss Experience Including a Literature Review

et al. 2017

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sociated with large polyp size ( p = 0.003) and lack of endoscopic prophylaxis ( p = 0.0008). Delayed post-polypectomy bleeding showed a trend in the occurrence of large polyps ( p = 0.064), and was statistically significantly associated with familial cancer syndrome ( p = 0.019) and advanced histopathology ( p = 0.013). Conclusion: Our data suggest that endoscopic polypectomy of NAD is well feasible with high success rates. Procedural and delayed hemorrhage seems to be the primary issue rather than adenoma recurrence. We therefore advocate referral of patients with large NAD to experienced centers for endoscopic resection.

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Early and delayed complications of polypectomy in a community setting: The SPoC prospective multicentre trial

Cited by 18 publications

References 35 publications

Colonoscopy-related adverse events and mortality in an Italian organized colorectal cancer screening program

Colonoscopy-related adverse events and mortality in an Italian organized colorectal cancer screening program

Clipping after large colorectal polyp resections reduces adverse events and allows ambulatory management

Nonampullary Duodenal Adenomas Rarely Recur after Complete Endoscopic Resection: A Swiss Experience Including a Literature Review

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