Postpolypectomy Bleeding

Kapetanos, Dimitrios; Beltsis, Athanasios; Chatzimavroudis, Grigoris; Katsinelos, Panagiotis

doi:10.1097/sle.0b013e318247c02e

Cited by 18 publications

(7 citation statements)

References 51 publications

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“…Of these, hemorrhage is the most common complication [5, 6, 7, 8, 9, 10]. Delayed hemorrhage following a polypectomy occurs between 3 to 7 days after the procedure, and its incidence is commonly reported to range between 0.6% and 0.9% [5, 6, 7, 8, 9]. Postpolypectomy delayed hemorrhage is unpredictable and can occur after hospital discharge; therefore, it requires attention.…”

Section: Introductionmentioning

confidence: 99%

Only the Size of Resected Polyps Is an Independent Risk Factor for Delayed Postpolypectomy Hemorrhage: A 10-Year Single-Center Case-Control Study

et al. 2014

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PurposeA colonoscopic polypectomy is an important procedure for preventing colorectal cancer, but it is not free from complications. Delayed hemorrhage after a colonoscopic polypectomy is one infrequent, but serious, complication. The aim of this study was to identify the risk factors for delayed hemorrhage after a colonoscopic polypectomy.MethodsThis was a retrospective case-control study based on medical records from a single gastroenterology center. The records of 7,217 patients who underwent a colonoscopic polypectomy between March 2002 and March 2012 were reviewed, and 92 patients and 276 controls were selected. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, resection method, and use of prophylactic hemostasis.ResultsThe average time between the procedure and bleeding was 2.71 ± 1.55 days. Univariate and multivariate analyses revealed that the size of the polyps was the only and most important predictor of delayed hemorrhage after a colonoscopic polypectomy (odds ratio, 2.06; 95% confidence interval, 1.12-1.27; P = 0.03).ConclusionThe size of resected polyps was the only independent risk factor for delayed bleeding after a colonoscopic polypectomy. The size of a polyp, as revealed by the colonoscopic procedure, may aid in making decisions, such as the decision to conduct a prophylactic hemostatic procedure.

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Section: Introductionmentioning

confidence: 99%

Only the Size of Resected Polyps Is an Independent Risk Factor for Delayed Postpolypectomy Hemorrhage: A 10-Year Single-Center Case-Control Study

et al. 2014

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“…Increased surveillance is recommended after polyps are found (7), further straining a medical system that already struggles to meet the demand for screening and diagnostic colonoscopies, both in terms of cost (8) and available providers (9). Additionally, colonoscopy and polypectomy are not without risk; colonic perforation occurs at a low but predictable rate during colonoscopy (10), and significant post-colonoscopy bleeding is more likely to occur after polypectomy (11). …”

Section: Introductionmentioning

confidence: 99%

Dynamic Tumor Growth Patterns in a Novel Murine Model of Colorectal Cancer

Olson

Hadac

Sievers

et al. 2014

Cancer Prevention Research

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Colorectal cancer (CRC) often arises from adenomatous colonic polyps. Polyps can grow and progress to cancer, but may also remain static in size, regress, or resolve. Predicting which progress and which remain benign is difficult. We developed a novel long-lived murine model of CRC with tumors that can be followed by colonoscopy. Our aim was to assess whether these tumors have similar growth patterns and histologic fates to human colorectal polyps to identify features to aid in risk-stratification of colonic tumors. Long-lived ApcMin/+ mice were treated with dextran sodium sulfate to promote colonic tumorigenesis. Tumor growth patterns were characterized by serial colonoscopy with biopsies obtained for immunohistochemistry and gene expression profiling. Tumors grew, remained static, regressed, or resolved over time with different relative frequencies. Newly developed tumors demonstrated higher rates of growth and resolution than more established tumors that tended to remain static in size. Colonic tumors were hyperplastic lesions (3%), adenomas (73%), intramucosal carcinomas (20%), or adenocarcinomas (3%). Interestingly, the level of β-catenin was higher in adenomas that became intratumoral carcinomas as compared to those that failed to progress. In addition, differentially expressed genes between adenomas and intramucosal carcinomas were identified. This novel murine model of intestinal tumorigenesis develops colonic tumors that can be monitored by serial colonoscopy, mirror growth patterns seen in human colorectal polyps, and progress to CRC. Further characterization of cellular and molecular features are needed to determine which features can be used to risk-stratify polyps for progression to CRC and potentially guide prevention strategies.

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“…Postpolypectomy bleeding (PPB) is the most common complication, with an incidence ranging from 0.6% to 8% in large series [1, 2, 3]. The incidence of PPB has been reported to depend on its definition: early, delayed, and overall [4]. …”

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confidence: 99%

“…Garcia et al [6] reported thromboembolic events in 0.7% of 1,293 patients with warfarin interruptions, and Blacker et al [7] reported that strokes occurred in 1% of 987 patients with atrial fibrillation after temporary anticoagulation discontinuation. Until now, 2014.30.4.157whether antiplatelet agents such as aspirin increase the risk of PPB has been debatable [4]. Among polyp-related factors associated with PPB, the size of the polyp, as Moon et al [8] showed in his retrospective study of the current issue, seems to have the most data supporting it.…”

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confidence: 99%

“…Each method has its own efficacy and its own advantages in reducing the risk of PPB; however, none of these methods is totally superior to the others. Kapetanos et al [4] summarized the key points from these randomized studies as follows: (1) The injection of saline-epinephrine solution at the base of the polyp can prevent early, but not delayed, bleeding. (2) Loop placement can prevent bleeding but, especially in large (>2 cm) polyps, this effect is restricted to early bleeding.…”

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confidence: 99%

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