Incidence of Delayed Post-Polypectomy Bleeding After Hot Biopsy and Hot Snare Polypectomy

Abstract

Purpose: The purpose of this study was to determine the overall incidence of delayed post-polypectomy bleeding and to investigate whether it was influenced by the polypectomy method. Methods: We performed a retrospective review of our endoscopy complication database and electronic medical record at Memorial Sloan-Kettering Cancer Center for patients between June 2005 and January 2009. Patients were included in the database if they notified the physician or presented to the hospital with rectal bleeding within 30 days of polypectomy. All patients also received a phone call from a nurse 1-2 days post-procedure. Polyp location and size, polypectomy method, use of anticoagulant or antiplatelet drugs, and post-polypectomy bleeding management were recorded. Statistical analysis was performed using Yates corrected chi square analysis. Results: A total of 12653 colonoscopies were performed; 3207 (25.3%) included polypectomy. We identified 36 patients (1.12%) with post-polypectomy bleeding (median age 67 [range 39-92]) with a median of 7 days (range 1-14) after polypectomy. There were 1932 colonoscopies with hot biopsy polypectomy (HBP), 760 with hot snare polypectomy (HSP), and 512 with both HBP and HSP. Bleeding occurred after HBP in 14 patients (0.72%) and after HSP in 12 patients (1.58%), which was not statistically significant (p=0.07). Ten patients (1.95%) with post-polypectomy bleeding had a colonoscopy with both HBP and HSP. Thirty-two patients (88.9%) were hospitalized and 11 patients (30.6%) underwent repeat colonoscopy; 4 required clipping and 2 required cautery or argon plasma coagulation. One patient underwent surgery after endoscopic management failed. Nine patients were transfused blood products (7 red blood cells, 5 platelets) and 19 underwent observation alone. NSAIDs, plavix, and low molecular weight heparin were used within 1 week of polypectomy by 16, 3, and 1 patient(s) respectively. Conclusion: The overall post-polypectomy bleeding rate in our study was approximately 1%, consistent with prior studies. Our study demonstrates that hot biopsy polypectomy is associated with a low rate of post-polypectomy bleeding which was not statistically significant from hot snare polypectomy.