Postpolypectomy Bleeding Reduction in an Outpatient Endoscopy Center

Abstract

Purpose: Postpolypectomy bleeding occurs in 1-2% of all colonoscopy polypectomy patients. The use of anticoagulant therapy is increasing in colonoscopy patients. A protocol was developed for patients taking anticoagulants to reduce the frequency of postpolypectomy bleeding in an outpatient endoscopy center. Methods: All records 15 months previous to the new protocol were reviewed identifying patients with significant postpolypectomy bleeding defined as a decrease in hgb of 2 grams or hospitalization. 1.4% of 1324 patients had bleeding and almost all were patients taking coumadin, plavix or NSAID. (Table 1). A protocol was developed which included identifying all anticoagulant use during a preprocedure encounter and a patient education program of the importance of stopping anticoagulation was instituted. Written patient instruction for a specific day to stop anticoagulation, notification to the prescribing physician of plans to stop anticoagulant therapy and verbal and written patient instructions when to resume anticoagulation following polypectomy were instituted. (see forms). Results: Prior to instituting our protocol the postpolypectomy bleeding frequency was 1.4% of 1324 procedures. After instituting our protocol the postpolypectomy bleeding frequency fell to 0.3% of 3030 patients. No patients following the protocol experienced a thrombotic event. Conclusion: A protocol involving precolonoscopy patient education, physician notification and post procedure patient instruction dramatically decreases postpolypectomy bleeding in an outpatient endoscopy center.