Outcomes and Risk Factors for Development of Post-Polypectomy Hemorrhage Requiring Hospitalization

Abstract

Purpose: To determine the risk factors related to post-polypectomy hemorrhage (PPH) and to determine outcomes of these complications. Background: PPH is a common complication following polypectomy with a reported frequency of 0.3 to 6%. Reported risk factors include polyp size, polyp morphology and patient age. Methods: All outpatients undergoing colonoscopy with polypectomy between January 1, 1999 and April 1, 2007 were included. Data pertaining to the colonoscopy and polypectomy was obtained using the endoscopic database maintained by the Gastroenterology department and analyzed retrospectively. Corporate data store was queried to obtain the list of patients that were admitted to the hospital within 30 days following the colonoscopy. Electronic medical records were reviewed to determine which of these patients were admitted with a diagnosis PPH. Statistical analysis was conducted using chi-square analysis. Results: There were 11,433 patients that had polypectomy performed, of which 36 were admitted due to PPH (0.31%). PPH varied based on the site of polypectomy. PPH was 0.62% following polyp removal from the cecum, 0.56% from ascending colon and 0.92% from hepatic flexure compared to 0% in transverse colon or splenic flexure, 0.27% in descending colon, 0.2% in sigmoid and 0.25% in rectum (P= 0.017 right colon sites compared with transverse and left colon sites). PPH occurred in 0.21% in patients undergoing polypectomy during screening vs 0.43% for other indications (P= 0.026). Bleeding occurred more commonly in males 0.47% vs females 0.19% (P= 0.003). Size of polyp >10 mm was associated with higher risk of PPH 0.56% vs 0.14% (P= 0.013). There was no association with race or type of bowel preparation used. 8 patients were admitted to the ICU. 22/36 (61%) patients required endoscopy for hemostasis and the remainder had spontaneous resolution of bleeding. Mean hospitalization time was 3.7 days. Conclusion: In our study we found that PPH is significantly higher in men. PPH occurs significantly more frequently with polyps greater than 10 mm. PPH appears to occur more frequently with polyps removed from the right colon as compared with those removed from the transverse and left colon. Finally, PPH appears to be more frequent following polypectomy in patients undergoing colonoscopy for a specific indication as compared with those undergoing polypectomy during screening. PPH was easily controlled in most patients with either observation or endocospic therapy.