Incidence and risk factors of delayed postpolypectomy bleeding in patients with chronic liver disease

Lee, Jun Young; Park, Sung Chul; Kim, Seung Up; Lee, Jeung Eun; Leem, Ga Lam; Kim, Yonsoo; Park, Jun Yong; Ahn, Sang Hoon; Han, Kwang Hyub

doi:10.3109/00365521.2015.1121513

Cited by 16 publications

(9 citation statements)

References 22 publications

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“…Conversely, Kwon et al did not nd any association in DPPB rate comparing endoscopists practicing more or less than 10 years [28]. Similarly, Lee et al found no difference in DPPB rate between procedures performed by fellows versus staff [29]. These data were similar to the present study, in that endoscopist experience did not affect the rate of DPPB.…”

Section: Discussionsupporting

confidence: 82%

Effect of Instruction on Preventing Delayed Bleeding After Colorectal Polypectomy and Endoscopic Mucosal Resection

Okugawa

Oshima

Nakai

et al. 2020

Preprint

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Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6 – 2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding. Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection.Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of delayed post-polypectomy bleeding. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of patients before and after instruction were compared. Univariate analysis and forward stepwise logistic regression analysis were performed to test the influence of factors in association with delayed post-polypectomy bleeding.Results: A total of 3318 polyps in 1002 patients were evaluated. The before-instruction group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. Polyp size, pedunculated type, polyp location, and rate of cold snare polypectomy did not differ between before and after instruction. Clip placement was significantly more common after instruction (22.6%, 416/1839) than before (9.7%, 144/1479, P < 0.01). Delayed post-polypectomy bleeding occurred in 1.1% of cases before instruction, and 0.4% after instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Multivariate logistic regression analysis showed that hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for delayed post-polypectomy bleeding even after instruction.Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

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Section: Discussionsupporting

confidence: 82%

Effect of Instruction on Preventing Delayed Bleeding After Colorectal Polypectomy and Endoscopic Mucosal Resection

Okugawa

Oshima

Nakai

et al. 2020

Preprint

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show abstract

“…Conversely, Kwon et al did not find any association in DPPB rate comparing endoscopists practicing more or less than 10 years [29]. Similarly, Lee et al found no difference in DPPB rate between procedures performed by fellows versus staff [30]. These data were similar to the present study, in that endoscopist experience did not affect the rate of DPPB.…”

Section: Discussionsupporting

confidence: 82%

Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

Okugawa

Oshima

Nakai

et al. 2021

JCM

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Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6–2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection. Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared. Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction. Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

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“…That study reported an increased incidence of delayed PPB (defined as >1 episode of hematochezia 6 hours to 30 days after colonoscopic polypectomy) among patients with LC when compared to patients with chronic hepatitis (13.8% vs. 4.2%). 26 However, the incidence of delayed PPB in cases of CP-B or C cirrhosis was relatively lower in our study due to the different definition of delayed PPB. In terms of immediate PPB, a retrospective study of 30 patients with LC showed that LCrelated variables did not significantly increase the risk for immediate PPB, but that result was due to the small sample size.…”

Section: Discussioncontrasting

confidence: 60%

Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy

et al. 2020

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Background/Aims: The risk for colonoscopic postpolypectomy bleeding (PPB) in patients with chronic liver disease (CLD) remains unclear. We determined the incidence and risk factors for colonoscopic PPB in patients with CLD, especially those with liver cirrhosis. Methods: We retrospectively reviewed the medical records of patients with CLD who underwent colonoscopic polypectomy at Seoul National University Hospital between 2011 and 2014. The study endpoints were immediate and delayed PPB. Results: A total of 1,267 consecutive patients with CLD were included in the study. Immediate PPB occurred significantly more often in the Child-Pugh (CP) B or C cirrhosis group (17.5%) than in the CP-A (6.3%) and chronic hepatitis (4.6%) groups (p<0.001). Moreover, the incidence of delayed PPB in the CP-B or C cirrhosis group (4.4%) was significantly higher than that in the CP-A (0.7%) and chronic hepatitis (0.2%) groups (p<0.001). The independent risk factors for immediate PPB were CP-B or C cirrhosis (p=0.011), a platelet count <50,000/μL (p<0.001), 3 or more polyps (p=0.017), endoscopic mucosal resection or submucosal dissection (p<0.001), and polypectomy performed by trainees (p<0.001). The independent risk factors for delayed PPB were CP-B or C cirrhosis (p=0.009), and polyps >10 mm in size (p=0.010). Conclusions: Patients with CP-B or C cirrhosis had an increased risk for bleeding following colonoscopic polypectomy.

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Incidence and risk factors of delayed postpolypectomy bleeding in patients with chronic liver disease

Abstract: Caution is needed when colonoscopic polypectomy is planned in patients with CLD who have larger polyps and cirrhosis.

Cited by 16 publications

References 22 publications

Effect of Instruction on Preventing Delayed Bleeding After Colorectal Polypectomy and Endoscopic Mucosal Resection

Effect of Instruction on Preventing Delayed Bleeding After Colorectal Polypectomy and Endoscopic Mucosal Resection

Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy

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