Abstract
BackgroundDelayed post-polypectomy bleeding (PPB) is a major complication of polypectomy. The effect of prophylactic hemoclipping on delayed PPB is uncertain. The aim of this study was to evaluate the effectiveness of prophylactic hemoclipping and identify the risk factors of delayed PPB.MethodsPatients with polyps sized 6 to 20 mm underwent snare polypectomy from 2015 to 2017 were retrospectively reviewed. The patients with prophylactic hemoclipping for delayed PPB prevention were included in the clipping group, and those without prophylactic hemoclipping were included in the non-clipping group.The incidence of delayed PPB and time to bleeding were compared between the groups. Multivariate analysis was used to identify the risk factors of delayed PPB. Propensity score matching was used to minimize potential bias.ResultsAfter propensity score matching, 612 patients with 806 polyps were in the clipping group, and 576 patients with 806 polyps were in the non-clipping group. There were no significant differences in the incidence of delayed PPB and days to bleeding between two groups (0.8% vs 1.3%, p = 0.4; 3.4 ± 1.94 days vs 4.13 ± 3.39 days, p = 0.94). In the multivariate analysis, the polyp size [Odds ratio (OR):1.16, 95% confidence interval (CI):1.01–1.16, p = 0.03), multiple polypectomies (OR: 4.64, 95% CI:1.24–17.44, p = 0.02) and a history of anticoagulant use (OR:37.52, 95% CI:6.49–216.8, p < 0.001) were associated with delayed PPB.ConclusionsIn polyps sized 6 to 20 mm, prophylactic hemoclip placement did not decrease the risk of delayed PPB. Patients without risk factors including multiple polypectomies and anticoagulant use are no need to performing prophylactic hemoclipping.
Highlights
Delayed post-polypectomy bleeding (PPB) is a major complication of polypectomy
In the patients with a single polypectomy, the polyp size was associated with delayed PPB (OR: 1.30; 95% Confidence interval (CI): 1.02–1.65; p = 0.03)
We demonstrated that the polyp size, multiple polypectomies, and a history of anticoagulant use in a single colonoscopy procedure were associated with delayed PPB
Summary
Delayed post-polypectomy bleeding (PPB) is a major complication of polypectomy. The effect of prophylactic hemoclipping on delayed PPB is uncertain. The aim of this study was to evaluate the effectiveness of prophylactic hemoclipping and identify the risk factors of delayed PPB. Colorectal cancer (CRC) is a major malignancy worldwide. Colorectal polyps removal by polypectomy is commonly performed to prevent the development of CRC [2]. Polypectomy is associated with several complications, such as post-polypectomy bleeding (PPB) and perforation. The incidence of delayed PPB has been reported to range from 0.65 to 4.3% in various clinical conditions [4,5,6,7]. Its incidence is low, delayed PPB is associated with severe complications leading to emergency medical interventions, such as hospitalization, blood transfusion, repeat colonoscopic interventions, angiography and even surgical interventions
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