Postpolypectomy Bleeding Research Articles

Endoscopic Treatment of Sessile Colorectal Polyp

Background: Endoscopic resection of sessile colonic polyps’ presents a number of unique challenges. Large sessile polyps are associated with the greatest risk of postpolypectomy bleeding, perforation and polyp recurrence, with massive submucosal scarring making subsequent attempts at endoscopic resection problematic. Objective: This study aimed to evaluate feasibility, safety, and the effectiveness of endoscopic treatment of colorectal benign-appearing polyps. Patients and methods: This prospective study was carried out on forty (40) consecutive patients at General Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt between January 2014 and August 2016. All patients were subjected to clinical evaluation including history taking, general examination, abdominal and per-rectal examinations. Results: Of the 40 cases with removed polyps, 10 cases were excised by cold biopsy forceps, 4 cases were excised by cold snare, 12 cases were excised by hot snare and 14 cases were excised by EMR with mucosal lifting according to the size of the polyp. Complications included nonspecific abdominal pain in 5 patients (12.5%) that were treated conservatively and bleeding in 3 (7.5%), two cases during procedure while 1 case presented 7 th day post procedure. One case transferred into open surgery due to perforation. All cases were treated endoscopically. Post-polypectomy surveillance permitted the detection and treatment of recurrent polyps in 3 cases that treated endoscopically with piece meal excision. Conclusion: This study showed that polypectomy of benign sessile colorectal polyps performed by an expert endoscopist is feasible, effective, and safe, even on an outpatient basis.

The effect of discontinuation of aspirin on colonoscopic postpolypectomy bleeding

AbstractBleeding is one of the most common complications after colonoscopic polypectomy. Several factors associated with postpolypectomy bleeding (PPB) have been discussed, but whether aspirin increases the risk remains controversial, and the effect of the discontinuation of aspirin on PPB is still unclear. We aim to identify the risk factors of PPB and to assess the effect of aspirin on PPB. Patients undergoing colonoscopic polypectomy between November 2013 and September 2014 were recruited to the retrospective study. Patients' demographics, clinical parameters, polyp characteristics, using of antithrombotics, and the prevalence of PPB were reviewed from electronic medical records. Multiple regression analysis was performed to identify independent risk factors associated with PPB. A total of 497 patients with 827 polyps removed were recruited to this study. The bleeding rate was significantly higher in patients on aspirin therapy (17.3% vs 6.3%, P = .005). In multiple logistic regression analysis, aspirin users (hazard ratio [HR]: 3.67, 95% confidence interval [CI]: 1.51‐8.89, P = .007) and bigger polyp removal (cut level 11.5 mm, HR: 1.14, 95% CI: 1.06‐1.23, P = .001) were the significant factors. In aspirin users, discontinuation of aspirin for 7 days before polypectomy was the independent protective factor of bleeding (HR: 0.13, 95% CI: 0.03‐0.75, P = .022), especially when the polyp was ≧12 mm. Our study found that use of aspirin and bigger polyp size are associated with colonoscopic postpolyectomy bleeding. Discontinuation of aspirin before polypectomy could decrease the bleeding while the polyp size was greater than 12 mm.

Endoscopic Management of Post-Polypectomy Bleeding.

Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.

Post-polypectomy bleeding in hot-snare polypectomy of colonic polyps under continued warfarin or short interruption of direct oral anticoagulants.

Newly published guidelines of the Japanese Gastroenterological Endoscopy Society (JGES) suggest to consider endoscopic procedures with high risk of bleeding without stopping warfarin and with stopping direct oral anticoagulants (DOACs) only on the day of the procedure. In this study, we aimed to test the validity of these recommendations. We retrospectively reviewed medical records of 344 patients with anticoagulant therapy who underwent hot-snare polypectomy between January 2012 and October 2018. Patients (n= 132) with interruption of anticoagulants (3-7days for warfarin and 2-3days for DOACs before the procedure) and without heparin-bridging were excluded. Among the remaining 212 patients, the incidence of post-polypectomy bleeding was compared between the following 2 patient groups: patients who had interruption of anticoagulants with heparin-bridging (HB group, n= 139) and patients treated according to the new JGES guideline (FG group, n= 73). The rate of post-polypectomy bleeding (PPB) in FG group (9.6%) was not significantly different from that in HB group (12.9%, p = 0.5). In subgroup analysis, the incidence of bleeding in patients with warfarin (12.2%) and with DOAC (6.3%) in FG group was not significantly different from corresponding figures in HB group (14.2%, 0%). In multivariate analysis, number of resected polyps was associated with PPB, but the administration of anticoagulants according to the new guidelines was not a significant risk factor for PPB (p= .98). Our study affirms the recommendations of JGES for the management of anticoagulants in patients who undergo colonic polypectomy regarding post-polypectomy bleeding.

Covering the Cover

Covering the Cover

A giant Brunner\u2019s gland hamartoma being treated as a pedunculated polyp: a case report

BackgroundWith the development and application of endoscopic technology, most pedunculated polyps can be absolutely resected with a complete specimen by hot snare polypectomy (HSP). Brunner’s gland hamartoma (BGH) is a rare benign small bowel tumor. The majority of BGH measuring about 2 cm in diameter, rarely larger than 5 cm. Most patients are asymptomatic, some may present with gastrointestinal hemorrhage or intestinal obstruction. Symptomatic larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically. Whether it is safe and effective that removing a BGH measuring about 7 cm by HSP is not known.Case presentationHere, we reported a rare case of a proximal duodenum pedunculated mass measuring about 7 cm which was responsible for the patient’s severe anemia. we treated it as a pedunculated polyp. After being pretreated the stalk with an endoloop which was placed around the base of the mass to prevent post-polypectomy bleeding (PPB), the pedunculated BGH was removed by HSP completely. The stalk of the mass was negative. We achieved a curative resection.ConclusionIt is a safe and effective for our patient to treat the pedunculated BGH measuring about 7 cm as a pedunculated polyp and remove it by HSP. And future prospective studies in larger cohorts are needed to confirm it.

Complications of cold versus hot snare polypectomy of 10-20 mm polyps: A retrospective cohort study.

Background and AimCold snare polypectomy is safe and efficacious for removing polyps <10 mm with reduced rates of delayed postpolypectomy bleeding and postpolypectomy syndrome. This technique can also be used for sessile polyps ≥10 mm; however, further evidence is required to establish its safety. The aim of this study was to compare intraprocedure and postprocedure adverse events in patients who underwent cold (CSP) versus hot snare polypectomy (HSP) of 10–20 mm sessile colonic polyps.MethodsElectronic medical records and endoscopy reports of all patients who underwent polypectomy for Paris 0‐IIa, Is, or 0‐IIa + Is 10–20 mm colonic polyps between January 2015 and June 2017 at three tertiary academic hospitals and one private hospital were retrospectively reviewed. Data on patient demographics, polyp characteristics, method of polypectomy, and intraprocedural and postpolypectomy adverse events were collected.ResultsA total of 408 patients (median age 67, 50% male) had 604 polyps, 10–20 mm in size, removed. Of these, 258 polyps were removed by HSP, with a median size of 15 mm (interquartile range [IQR] 12–20), compared to 346 polyps that were removed by CSP, with median size of 12 mm (IQR 10–15), P < 0.001. In the HSP group, 15 patients presented with postprocedure complications, including 11 with clinically significant bleeding, 2 with postpolypectomy syndrome, and 2 with abdominal pain. This compares with no postpolypectomy complications in the CSP group, P < 0.001.ConclusionIn this study, CSP was not associated with any postpolypectomy adverse events. CSP appears to be safer than HSP for removing 10–20 mm‐sized sessile polyps. A prospective multicenter study has been commenced to verify these findings and to assess the efficacy of CSP for the complete resection of polyps of this size.

In CVD, continuing vs interrupting clopidogrel before colonoscopy did not differ for delayed postpolypectomy bleeding.

Source Citation Chan FK, Kyaw MH, Hsiang JC, et al. Risk of postpolypectomy bleeding with uninterrupted clopidogrel therapy in an industry-independent, double-blind, randomized trial. Gastroenterol...

Continuous Anticoagulation and Cold Snare Polypectomy Versus Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps

Management of anticoagulants for patients undergoing polypectomy is still controversial. Cold snare polypectomy (CSP) is reported to cause less bleeding than hot snare polypectomy (HSP). To compare outcomes between continuous administration of anticoagulants (CA) with CSP (CA+CSP) and periprocedural heparin bridging (HB) with HSP (HB+HSP) for subcentimeter colorectal polyps. Multicenter, parallel, noninferiority randomized controlled trial. (University Hospital Medical Information Network Clinical Trials Registry: UMIN000019355). 30 Japanese institutions. Patients receiving anticoagulant therapy (warfarin or direct oral anticoagulants) who had at least 1 nonpedunculated subcentimeter colorectal polyp. Patients were randomly assigned to undergo HB+HSP or CA+CSP and followed up 28 days after polypectomy. The primary end point was incidence of polypectomy-related major bleeding (based on the incidence of poorly controlled intraprocedural bleeding or postpolypectomy bleeding requiring endoscopic hemostasis). The prespecified inferiority margin was -5% (CA+CSP vs. HB+HSP). A total of 184 patients were enrolled: 90 in the HB+HSP group, 92 in the CA+CSP group, and 2 who declined to participate after enrollment. The incidence of polypectomy-related major bleeding in the HB+HSP and CA+CSP groups was 12.0% (95% CI, 5.0% to 19.1%) and 4.7% (CI, 0.2% to 9.2%), respectively. The intergroup difference for the primary end point was +7.3% (CI, -1.0% to 15.7%), with a 0.4% lower limit of 2-sided 90% CI, demonstrating the noninferiority of CA+CSP. The mean procedure time for each polyp and the hospitalization period were longer in the HB+HSP than in the CA+CSP group. An open-label trial assessing 2 factors (anticoagulation approach and polypectomy procedure type) simultaneously. Patients having CA+CSP for subcentimeter colorectal polyps who were receiving oral anticoagulants did not have an increased incidence of polypectomy-related major bleeding, and procedure time and hospitalization were shorter than in those having HB+HSP. Japanese Gastroenterological Association.

Unusual Causes of Abdominal Pain after Colonoscopy: A Case Series

AbstractColonoscopy is a relatively safe procedure with an overall complication rate between 0.2 and 0.35%. Complications do occur, however, including preparation related complications, colonic perforation, postpolypectomy hemorrhage, postpolypectomy coagulation syndrome, and other less-common miscellaneous complications. Abdominal pain is one of the more common complaints that symptomatic patients will present with after a colonoscopy, occurring up to 5% of the time. Although the cause is usually minor and does not require further workup, gastroenterologists are most concerned about perforation and postpolypectomy coagulation syndrome in the setting of severe abdominal pain. However, as gastroenterologists, we must also be cognizant that there may be other less-common causes of the abdominal pain. The four cases presented here illustrate rare presentations of abdominal pain after colonoscopy, consisting of acute diverticulitis, incarcerated umbilical hernia, acute gangrenous cholecystitis, and rupture of the ovarian cyst.

Tu1945 A NOVEL TECHNIQUE USING ENDOSCOPIC BAND LIGATION FOR REMOVAL OF LONG-STALKED PEDUNCULATED COLON POLYP

Bleeding is the most common complication associated with polypectomy of large pedunculated colonic polyp. Although several techniques have been developed to minimize bleeding, none of these methods has become the gold standard. To prevent post-polypectomy bleeding effectively, we developed and attempted a new endoscopic technique for removal of large long-stalked pedunculated colonic polyps using band ligations.

Efficacy of Prophylactic Hemoclips in Prevention of Delayed Post-Polypectomy Bleeding in Patients With Large Colonic Polyps

The efficacy of prophylactic placement of hemoclips to prevent delayed bleeding after removal of large colonic polyps has not been established. We conducted a randomized equivalence study to determine whether prophylactic placement of hemoclips affects incidence of delayed post-polypectomy bleeding (PPB). During elective colonoscopy performed at 4 Veterans Affairs Medical Centers, 1098 patients who had polyps ≥1 cm removed were randomly assigned to groups that received prophylactic hemoclips (n= 547) or no hemoclips (n= 551), from September 2011 through September 2018. Data on PPB (rectal bleeding resulting in hemoglobin decreases ≥2 g/dL, hemodynamic instability, colonoscopy, angiography, or surgery) within 30 days of colonoscopy (called delayed PPB) were collected during telephone interviews or hospital visits 7 and 30 days after colonoscopy. The primary outcome was theincidence of important post-polypectomy bleeding. Twelve patients in the hemoclip group (2.3%) and 15 patients in the no hemoclip group (2.9%) had important delayed PPB. There were no deaths, and no patients in either group required angiography or surgery. In intention-to-treat analysis, two 1-sided test's lower and upper confidence interval limits were -2.07 and 1.01, indicating that the data approached but did not meet equivalence criteria. On multiple logistic regression analysis, significant predictors of PPB included use of warfarin with bridging, thienopyridines, polyp size, and polyp location, but hemoclip placement did not associate with important delayed PPB. In a randomized trial, we found that prophylactic placement of hemoclips after removal of large colon polyps does not affect the proportion of important delayed PPB events, compared with no hemoclip placement. These findings call into question the widespread, expensive practice of routinely placing prophylactic hemoclips after polypectomy. ClinicalTrials.gov ID: NCT01647581.

Endoclip line-assisted traction to control cardial postpolypectomy bleeding.

Endoclip line-assisted traction to control cardial postpolypectomy bleeding.

Clip Closure for Postpolypectomy Bleeding Prevention

After endoscopic resection of large colorectal polyps, closing polypectomy defects with clips is thought to decrease severe bleeding risk, but

Feasibility and economic assessment of chromocolonoscopy for detection of proximal serrated neoplasia within a population-based colorectal cancer screening programme (CONSCOP): an open-label, randomised controlled non-inferiority trial

Most post-colonoscopy interval colorectal cancers are proximal; serrated polyps are often precursors to these cancers and are considered difficult to detect. We assessed the safety, feasibility, and economic effect of chromocolonoscopy on detection of proximal serrated neoplasia. We did an open-label, multicentre, randomised, controlled non-inferiority trial including patients from Bowel Screening Wales centres. Participants who tested positive for faecal occult blood and who were eligible for and considered fit to have colonoscopy (patients with known cases of polyposis syndromes, Lynch syndrome, and chronic inflammatory disease were excluded) were randomly assigned (1:1; with the use of minimisation, stratified by centre with an 80:20 random element) to either standard white light colonoscopy (standard group) or chromocolonoscopy (indigo carmine dye [0·2%]; chromocolonoscopy group) using a secure, internet-based, computerised, randomisation system that used centralised, dynamic allocation. Participants were followed up for 1 year and data from index colonoscopies and associated clearance procedures were analysed. All proximal polyps were reviewed by an expert pathologist panel. The main outcome on which power was based was time taken to perform the colonoscopy procedure, defined as from the time when the scope was inserted to withdrawal from the anus, assessed in the per-protocol population. The non-inferiority margin was 15 min. This trial is complete and is registered with ClinicalTrials.gov, number NCT01972451. Between Nov 20, 2014, and June 16, 2016, 741 (72%) of 1031 patients screened were eligible and consented: 360 were randomly assigned to white light colonoscopy and 381 to chromocolonoscopy. In the chromocolonoscopy group, the procedure took a mean of 36·8 min (SD 15·0), compared with a mean of 30·6 min (13·7) in the standard group (mean difference 6·3 min [95% CI 4·2-8·4] longer with chromocolonoscopy than in the standard group). The mean difference was within the prespecified non-inferiority margin. Detection rates for proximal serrated lesions were significantly higher in the chromocolonoscopy group than in the control group (45 [12%] of 381 patients vs 23 [6%] of 360 patients; odds ratio 1·96 [95% CI 1·16-3·32]; p=0·012). Serious adverse events (four cases of postpolypectomy bleeding [two in each group], and one case of anxiety and hyperventilation [in the chromocolonoscopy group]), colonoscopy quality measures, comfort scores, and sedation were similar between groups. Chromocolonoscopy is feasible within a population-based colorectal cancer screening programme, is safe, and has significantly increased detection of proximal serrated neoplasia and other polyp types compared with standard colonoscopy. Larger randomised trials of chromocolonoscopy, powered for improved detection of significant serrated polyps and for longer-term follow-up to investigate the effect on reduction of interval cancers within screening populations, are warranted. Health and Care Research Wales (RfPPB-1021).

Low endoscopy bleeding risk in patients with congenital bleeding disorders.

Haemophilia A and haemophilia B, von Willebrand disease (VWD), factor VII deficiency and factor XI deficiency are congenital bleeding disorders predisposing to bleeding during invasive procedures. The ageing population of people with congenital bleeding disorders will likely increasingly require gastrointestinal endoscopy. The bleeding risk postgastrointestinal endoscopy and optimal prophylactic treatment regimens are not well described. We performed a retrospective chart review at the McGill University Health Centre. Adult patients with haemophilia A or B, VWD, FVII deficiency and FXI deficiency who underwent gastrointestinal endoscopic procedures were included. Bleeding prophylaxis included combinations of plasma-derived factor (VWD) or recombinant factor (haemophilia A and haemophilia B), desmopressin and/or tranexamic acid. Our primary outcome was the 72-hour postendoscopy bleeding rate. One hundred and four endoscopies were performed in 48 patients. Haemophilia A (45.3% of endoscopies) was the most common bleeding disorder, followed by VWD (38.5%), FXI deficiency (8.7%), haemophilia B (4.8%) and FVII deficiency (2.9%). All patients were reviewed by the Haemophilia Treatment Center with peri-procedure treatment protocols put in place as required. The overall 72-hour bleeding rate was 0.96%, confidence interval (CI) 95% (0.17%-5.25%). The colonoscopic postpolypectomy bleeding rate was 1/21 (4.8%, CI 95% (0.9%-22.7%)) in comparison with the general population rate of 0.3%-10% for high-risk endoscopy (including colonoscopic polypectomy). To the best of our knowledge, this is the largest study describing patients with inherited bleeding disorders undergoing gastrointestinal endoscopy. The bleeding risk is not significantly higher to the general population when haemostatically managed by a team experienced in bleeding disorders.

Cold guillotine of adherent clot in delayed post-polypectomy bleeding

Biological therapies have modified the disease course of pediatric inflammatory bowel disease (IBD) and are routinely used in clinical practice. Our observational study aims to evaluate effectiveness and safety of biologics in IBD.Clinical benefit and safety data of 93 children with IBD, receiving biologics (Infliximab – IFX, Adalimumab – ADA, Golimumab – GOL) from January 2013 to December 2017, were extracted from the cohort of the Sicilian Network of IBD.Among 87 children aged 7–17 years (63 Crohn's disease [CD], 24 Ulcerative colitis [UC]), 101 out of 108 biologic treatments were considered. Evaluation of 74 biologic treatments in CD patients at 26, 52, 104 weeks showed clinical benefit rates of 84.2%, 93.3%, 66.7% with IFX (n = 38) and 88.9%, 84.4%, 65.2% with ADA (n= 36). Biologic treatments (n = 27) evaluated in the UC group at 26, 52, 104 weeks, led to clinical benefit rates of 85.7%, 83.3%, 50% in IFX subgroup (n = 21) and 40%, 50%, 33% in the ADA subgroup (n = 5), respectively. One patient treated with GOL showed 100% clinical benefit at 26 and 52 weeks. Overall adverse events (AEs) rate was 9.25%. Six younger children, < 6 years, receiving 8 treatments (4 ADA, 4 IFX) presented a clinical remission rate of 75% at 12 weeks and 25% at 52 weeks. AEs rate was 25% in this group.Our data show that biologic therapy in children, even at a younger age, is effective in allowing long-term remission with a good safety profile.

Safety of Cold Snare Polypectomy in Patients Receiving Treatment with Antithrombotic Agents.

With the aging of the population and rising incidence of thromboembolic events, the clinical use of antithrombotic agents is also increasing. There are few reports yet on the management of antithrombotic agent use in patients undergoing cold snare polypectomy (CSP). The aim of this study was to evaluate whether continued administration of antithrombotic agents in patients undergoing CSP would be associated with an increased rate of delayed post-polypectomy bleeding (DPPB). A total of 1177 colorectal polyps in 501 patients were resected at Omori Red Cross Hospital between October 2017 and March 2018. The polyps were divided into two groups depending on whether the patients received antithrombotic agent treatment or not: the antithrombotic group (911 polyps) and the no-antithrombotic group (266 polyps). Among the 1177 polyp resections, there was no case of DPPB, including in the antithrombotic group. Immediate bleeding occurred in a total of 63 (5.4%) cases. Polyp location in the rectum (OR (95% CI) 2.64 (1.223-5.679); p = 0.013), polyp size ≥ 6mm (OR (95% CI) 4.64 (2.719-7.933); p < 0.001), polypoid growth pattern (OR (95% CI) 2.78 (1.607-4.793); p < 0.001), and antithrombotic agent use (OR (95% CI) 2.98 (1.715-5.183); p < 0.001) were identified as significant risk factors of immediate bleeding. Continued use of antithrombotic agents does not increase the risk of DPPB, even in those receiving multiple antithrombotic agents. Thus, it is safe to perform CSP even in multiple agent users. Prospective, randomized studies are necessary to confirm our results.

Heparin bridge is associated with more post-polypectomy bleeding and emergency department visits among anticoagulated patients

Background:Among patients undergoing colonoscopy, anticoagulants are usually stopped and are sometimes substituted by a heparin bridge (hep-bridge). We aimed to assess adverse events associated with hep-bridge compared to temporary cessation of anticoagulants (no-bridge).Methods:This was a single-center, retrospective cohort study that included anticoagulated patients undergoing colonoscopy between 2013 and 2016 at a Veterans Affairs Medical Center. In the no-bridge cohort, warfarin was stopped for 5 days and novel anticoagulants for 2 days pre-procedure. In the hep-bridge cohort, anticoagulants were stopped and were substituted by subcutaneous enoxaparin. The primary outcome was post-polypectomy bleeding. Secondary outcomes included cardiovascular events, all-cause adverse events and emergency department or unscheduled ambulatory office visits within 30 days. The predictive values of the HAS-BLED and CHADS2 scores were evaluated.Results:A total of 662 patients were included, of whom 551 underwent polypectomy (mean age 68.6 years; 97.6% male). Four hundred seventy colonoscopies were performed with no-bridge and 192 with hep-bridge. Post-polypectomy bleeding occurred in 6.0% of procedures: 5.7% in the no-bridge cohort compared to 13.0% of hep-bridge procedures (P=0.0038). Cardiovascular or thrombotic events occurred after 2.6% of the no-bridge and 5.2% of the hep-bridge procedures (P=0.1176). Emergency department or unscheduled office visits within 30 days were reported after 18.7% of the no-bridge procedures and 29.7% of the hep-bridge procedures (P<0.0001). Neither CHADS2 nor HASBLED scores predicted bleeding.Conclusion:The use of hep-bridge was associated with a greater incidence of post-polypectomy bleeding and more emergency department and unscheduled office visits compared with cessation of all anticoagulants.

The risk of bleeding following therapeutic endoscopy is low in patients with cirrhosis

Background: Patients with cirrhosis may be at increased risk of bleeding after invasive procedures due to defects in coagulation; however the bleeding risk following therapeutic endoscopy remains poorly understood. We aimed to determine the incidence and risk factors for post-procedural bleeding for patients with cirrhosis undergoing therapeutic endoscopy.&#x0D; Methods: We performed a retrospective cohort study of patients undergoing three common endoscopic procedures (colonoscopic polypectomy, endoscopic variceal ligation, and biliary sphincterotomy) at Indiana University Hospital between 2007 and 2014. Clinical and procedural data were collected, including complications in the 30 days following the proceduress. &#x0D; Results: We identified 447 procedures: 128 polypectomies, 63 sphincterotomies, and 256 variceal ligations. The incidence of bleeding was 2% (4 polypectomies, 1 sphincterotomy, and 4 variceal ligations) after a median of 4.5 days. . Prophlactic platelet transfusions were provided to 11 patients and plasma was transfused in 17 patients. Of those who received prophylactic transfusions, only one bled (post-polypectomy despite prophylactic hemoclip placement). The patients that bled had a median INR of 1.48 which was slightly elevated compared to the overall median INR 1.26. Post-polypectomy bleeding occurred following removal of fairly large polyps (8, 9, 10, 25 mm) compared to the median overall polyp size of 5 mm. &#x0D; Conclusion: The incidence of bleeding for patients with cirrhosis undergoing therapeutic endoscopy is low. More data on post-procedural bleeding are needed to determine risk factors and to inform appropriate prophylactic measures. These data may be used to guide clinicians in counseling patients prior to these procedures.