Hemorrhagic Complication of Endoscopic Polypectomy Is Liable to Occur in Patient with Hypertension

Abstract

(Introduction) Hemorrhagic complication of endoscopic polypectomy is occasionally serious and life threatening. Hemorrhage during the procedure is able to be controlled using appropriate devices such as hemostatic clips or others. However, hemorrhage after the procedure is difficult to predict and we have no means to completely prevent it. The aim of this study is to assess the risk factors of hemorrhage after endoscopic polypectomy. Special attention was given not only to features of polyps but also to patients' characteristics. (Method) Between October 1995 and August 2003, 3138 cases with 6617 colorectal polyps underwent endoscopic resection at our hospital. We advised all patients to stop drinking and hard exercise for 7 days after the day of endoscopic resection. We conducted medical interview to the patients at 14 days after the day of resection, asking whether bloody feces appeared twice or more. We conducted a case control study using a control group matched by age, sex, features of tumor including size, shape and location of tumors, and method of resection. We compared alcohol consumption, smoking habit, presence of hypertension, diabetes mellitus, or hyperlipidemia between cases with hemorrhage after the procedure and those without. (Result) Hemorrhage after the procedure occurred to 38 lesions (0.57%) in 37 cases (1.18%). Of these, 22 cases needed endoscopic procedures for hemostasis, and only one case required blood transfusion. The size of tumors with hemorrhagic complication was larger than that of not complicated tumors; 10.0±6.9 mm in the former and 5.6±3.8 mm in the latter (P<0.0001). Hemorrhage occurred to 11/3733 lesions (0.29%) by hot biopsy, 23/2492 (0.92%) by snare polypectomy, and 4/362 (1.10%) by endoscopic mucosal resection, respectively. In the case control analysis, 67.6% (25/37) of the case subjects with hemorrhage had hypertension, as compared with 28.4% (21/74) of the controls. Adjusted odds ratio was 4.7(95% CI;1.8-12.1, P=0.001). There was no difference in alcohol consumption, smoking, presence of diabetes mellitus or hyperlipidemia between cases and controls. Furthermore, among the patients with hemorrhagic complication, the mean time to occurrence of hemorrhage was significantly longer in cases with hypertension than those without; 4.9±3.5 days in the former and 2.3±2.7 days in the latter (P=0.04). (Conclusion) Hypertension is a significant risk factor of hemorrhagic complication. Especially, in cases with hypertension, late onset hemorrhage is liable to occur.