Risk Factors for Immediate Postpolypectomy Bleeding of the Colon: A Multicenter Study

Abstract

OBJECTIVES: The aims of this prospective study were to document the incidence of colon immediate postpolypectomy bleeding (IPPB) according to grade, and to identify potential risk factors of IPPB in patients who have received complete colonoscopy and polypectomy because of a colorectal polyp. METHODS:This was a prospective, cross-sectional study of 5,152 patients treated at 11 tertiary medical centers between July 2003 and July 2004. Patient-related, polyp-related, and procedure-related variables were evaluated as potential risk factors for IPPB. IPPB was defined as a bleeding occurring during the procedure and was graded as G1-G4. Risk factors associated with IPPB were analyzed by univariate and multivariate logistic regression analysis. RESULTS:A total of 9,336 colonic polyps were removed in 5,152 patients, and 262 (2.8%) colorectal polyps in 215 patients presented with IPPB. Polyp-based multivariate analysis revealed that old age (≥65 yr), comorbid cardiovascular or chronic renal disease, anticoagulant use, polyp size greater than 1 cm, gross morphology of polyps such as pedunculated polyp or laterally spreading tumor, poorer bowel preparation, cutting mode of the electrosurgical current, and the inadvertent cutting of a polyp before current application were significant risk factors for IPPB.CONCLUSION: Nine factors have been found to be associated with IPPB and polypectomy should be undertaken with caution under these conditions.

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…93 Use of pure cutting current was found to be an independent predictive factor of immediate PPB compared with blended or coagulation current in a large cohort of 5152 patients undergoing more than 9000 polypectomies (OR, 6.95; 95% CI 4.42 to 10.94). 94 In a prospective cohort study, the use of a non microprocessorcontrolled current was an independent predictive factor of delayed bleeding when performing a wide field EMR. 32 Two recent meta-analyses have examined data on RCTs for PPB prophylaxis.…”

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

“…Although antithrombotic therapy is effective for the prevention of ischemic cardiovascular events, the recent use of anticoagulants or antiplatelet agents is considered a major risk factor for POB following EP and EMR [18][19][20] . According to the recent guidelines of the Japan Gastroenterological Endoscopic Society (JGES), anticoagulants or antiplatelet agents should not be discontinued before endoscopic procedures with low risk of bleeding since the withdrawal of these drugs may cause new-onset cardiovascular events [21] .…”

Colonoscopia com polipectomia: análise crítica de fatores de risco e complicações

“…As principais complicações em polipectomia com alça diatérmica são sangramento, perfuração e dor abdominal 14,15 e estão associadas ao tamanho do pólipo 7,16,17,18,19,20 e são aqui demonstradas nas Tabelas 1, 2, 3 e 4. O tratamento destas complicações, em colonoscopia terapêutica, costuma ser por via endoscópica para hemorragia e conservador, não cirúrgico, para perfuração [21][22] .…”