Risk Factors For Postpolypectomy Bleeding Research Articles

Risk factors for post-polypectomy bleeding in patients with end-stage renal disease undergoing colonoscopic polypectomy.

Little is known about the risk factors of bleeding after colonoscopic polypectomy in patients with end-stage renal disease (ESRD). This study investigated the incidence and risk factors of post-polypectomy bleeding (PPB), including immediate and delayed bleeding, in patients with ESRD. Ninety-two patients with ESRD who underwent colonoscopic polypectomy between September 2005 and June 2020 at a single tertiary referral center were included. The patients' medical records were retrospectively reviewed. Patient- and polyp-related factors associated with immediate PPB (IPPB) were analyzed using logistic regression analysis. Additionally, the optimal cutoff polyp size related to a significant increase in the risk of IPPB was determined by performing receiver operating characteristic (ROC) analysis and calculating the area under the ROC curve (AUC). In total, 286 polyps were removed. IPPB occurred in 24 (26.1%) patients and 46 (16.1%) polyps and delayed PPB occurred in 2 (2.2%) patients. According to multivariate analysis, the polyp size (> 7mm), old age (> 70), and endoscopic mucosal resection (EMR) as the polypectomy method (EMR versus non-EMR) were found to be independent risk factors for IPPB. According to the Youden index method, the optimal cutoff polyp size to identify high-risk polyps for IPPB was 7mm (AUC = 0.755; sensitivity, 76.1%; specificity, 69.6%). Colonoscopic polypectomy should be performed with caution in patients with ESRD, especially in those with the following risk factors: advanced age (> 70years), polyp size > 7mm, and EMR as the polypectomy method.

Risk factors of post-polypectomy bleeding and recurrence in children with colorectal polyps after endoscopic mucosal resection: a retrospective cohort study.

The incidence rate of colorectal polyps in children has gradually increased in recent years. It is still unclear whether endoscopic mucosal resection (EMR) can be performed in children with colorectal polyps as well as their incidences of post-polypectomy bleeding and recurrence. This retrospective study was performed to explore the feasible of EMR in children with colorectal polyps and analyze the risk factors of post-polypectomy bleeding and recurrence. Patients aged younger than 18 years diagnosed with colorectal polyps and received EMR for polypectomy between January 2017 and December 2021 were included in this study. The baseline data of included patients were retrospectively collected. All complications related to polypectomy were recorded during follow up via telephone, internet, or outpatient department, including post-polypectomy bleeding, perforation and polyp recurrence. Patients with and without post-polypectomy complications were divided into 2 groups. The risk factors of post-polypectomy bleeding and polyp recurrence were analyzed using multivariable logistic regression models after adjusting potential risk factors using univariable regression models. A total of 589 patients were included in this retrospective study. There were 333 male patients and 256 female patients, and their average age was 4.4±1.9 years old. The average diameter of their polyps was 8.4±2.8 mm, and 542 (92.0%) polyps presented as pedunculated lesions. A total of 540 (91.7%) polyps were diagnosed as juvenile polyps and 509 (86.4%) patients had only 1 polyp. There were a total of 75 cases of post-polypectomy complications (12.7%). The most common complication was early post-polypectomy bleeding (5.3%), followed by polyp recurrence (3.7%). Post-polypectomy bleeding occurred the most on the third and fourth day after EMR polypectomy. Larger polyps (OR =1.742, P<0.001), sessile lesions (OR =3.150, P=0.019), and multiple polyps (OR =4.372, P=0.003) were identified to be related to the incidence of post-polypectomy bleeding. Besides, sessile lesions (OR =3.887, P=0.026) were identified as the main risk factor and older patients (OR =0.606, P=0.004) had lower potential for post-polypectomy recurrence. More attention should be paid to large, sessile, and multiple polyps during the procedure of EMR in children. The small number of patients in this study limits further analysis of results and a large sample study should be performed.

Analysis of risk factors for post-polypectomy bleeding and polyp recurrence after colonoscopic polypectomy in children

Objective: To explore the incidence and the risk factors of post-polypectomy bleeding and polyp recurrence after colonoscopic high-frequency electrocoagulation snare polypectomy. Methods: Clinical data of 1 826 children who underwent colonoscopic high-frequency electrocoagulation snare polypectomy in the Children's Hospital, Zhejiang University School of Medicine from January 2009 to December 2020 was retrospectively analyzed. Demographic characteristics, endoscopic manifestations, pathological features, diagnosis, occurrence of post-polypectomy bleeding and polyp recurrence were collected. The associated risk factors were analyzed by Logistic regression. Results: A total of 1 826 children (1 191 males and 635 females) with 1 967 polypectomies were included. The age was 4.6 (3.2, 6.4) years at initial diagnosis. According to the initial colonoscopy, 1 611 children (88.2%) had solitary polyps, 1 707 children (93.5%) had pedicled polyps, 1 151 children (63.0%) had polyps involving the rectum, and 1 757 children (96.2%) had hamartomatous polyps. Polyposis syndromes were diagnosed in 73 children (4.0%). The post-polypectomy bleeding occurrence was 3.8% (75/1 967). Polyps recurred in 88 children (4.8%). Girls (OR=2.01, 95%CI 1.26-3.23) and sessile polyps (OR=2.28, 95%CI 1.15-4.49) were risk factors for post-polypectomy bleeding (both P<0.05). Multiple polyps (OR=17.49, 95%CI 9.82-31.18), right-colon involvement (OR=3.44, 95%CI 1.89-6.26) and non-hamartoma (OR=2.51, 95%CI 1.04-6.07) were risk factors for polyp recurrence (all P<0.05). Conclusions: Colonoscopic high-frequency electrocoagulation snare polypectomy has low incidence of post-polypectomy bleeding and polyp recurrence. Female patients and sessile polyps have higher risk for post-polypectomy bleeding. Multiple polyps, right-colon involvement and non-hamartoma polyps increase the risk for polyp recurrence.

Effectiveness of prophylactic clipping in preventing postpolypectomy bleeding in oral anticoagulant users: a propensity-score analysis

Evidence of prophylactic clipping is inconsistent except for proximal and large colonic lesions in the general population. Although warfarin and direct oral anticoagulants (DOACs) are significant risk factors of postpolypectomy bleeding (PPB), dedicated studies to examine the benefit of prophylactic clipping in these high-risk patients remain limited. We performed a propensity score-weighted retrospective cohort study from 2012 to 2020. Patients who received an oral anticoagulant and underwent colonoscopic polypectomy were included. Data were collected on baseline demographics, medications (anticoagulant, antiplatelet, and heparin bridging), and endoscopies (polyp number, location, size, morphology, histopathology, resection method and prophylactic clipping). Propensity-score models with inverse probability of treatment weighting were developed between prophylactic clipping and no clipping groups. Unbalanced variables were included in a doubly robust model with multivariate analysis. The primary outcome was clinically significant delayed PPB, defined as a composite endpoint of hemoglobin drop≥2 g/dL, blood transfusion, or repeat colonoscopy for hemostasis within 30 days. Five hundred forty-seven patients with 1485 polyps were included. Prophylactic clipping was not associated with a reduced risk of PPB (odds ratio [OR], 1.19; 95% confidence interval [CI], .73-1.95; P= .497). The hot resection method was associated with a significantly higher risk of PPB (OR, 9.76; 95% CI, 3.94-32.60; P< .001) compared with cold biopsy or snare polypectomy. In a subgroup analysis, prophylactic clipping was associated with a lower PPB risk in patients on DOACs (OR, .36; 95% CI, .16-.82; P= .015). Prophylactic clipping was not associated with an overall reduced risk of PPB in patients on oral anticoagulants. The use of cold snare polypectomy should be maximized in anticoagulated patients.

Risk factors for post-polypectomy bleeding; a retrospective case-control study of a high-volume colonoscopy center.

Post-polypectomy bleeding (PPB) remains an uncommon although serious complication of colonoscopy. The aim of this study is to determine the PPB-prevalence in a secondary care hospital and its associated risk factors. We collected data from 581 patients, with the removal of 1593 polyps between August 2017 and August 2019. A univariate binary logistic regression analysis was conducted retrospectively. PPB occurred in only 10 cases, representing 1.7% of patients: immediate in 1.2% and delayed in 0.5%. The number of removed polyps per patient [4.5 (SD 2.59) for hemorrhagic vs. 2.74 (SD 1.98) for non-hemorrhagic group] and the propofol dose [232 mg (SD 93.07) for hemorrhagic vs. 133 mg (SD 57.28) for non-hemorrhagic group] were relevant patient-related risk factors. The polyp-based analysis showed the polyp size [18.4 mm (SD 10.44) for hemorrhagic vs. 4.42 mm (SD 4.29) for non-hemorrhagic group], the morphology [wide-based: OR 24.83 (95 % CI 2.76 - 223.44), pedunculated: OR 56.67 (95 % CI 5.03 - 638.29)], the location at ileocecal valve [OR 20.48, 95 % CI 1.81 - 231.97)], and the polypectomy method [hot snare piecemeal with epinephrine injection: OR 75.38 (95 % CI 7.67 - 741.21)] as significant risk factors for PPB, too. The low rate of PPB confirms the safety of the procedure in non-tertiary, high-volume colonoscopy centers. The number of polyps removed per patient, the polyp size, morphology and location, as well as the sedation dose and the method of polypectomy were shown as relevant risk factors.

Risk Factors Associated With Postendoscopic Mucosal Resection Bleeding in Patients With Cirrhosis: A Retrospective Multicenter Cohort Study.

There is limited data regarding the safety of endoscopic mucosal resection (EMR) in the cirrhotic population. Our study aimed to evaluate the safety of colonoscopic EMR in cirrhosis. This was a retrospective review of cirrhotics who underwent colonic EMR at 8 Cleveland Clinic Centers between January 1, 2006, and December 31, 2018. Patient data including polyp details and complications occurring within 30 days of the procedure were noted. Univariable and multivariable logistic regression analyses were conducted to find risk factors for post-EMR bleeding. A total of 238 patients who underwent EMR were included. There were 145 males (60.9%) and the mean age was 61.9±8.6 years. Immediate and delayed bleeding, and postpolypectomy syndrome rates were 9.2%, 5.8%, and 1.3%, respectively. Significant risk factors for postpolypectomy bleeding were: increased age (P=0.001), procedure duration >37 minutes (P=0.001), antiplatelet use within 5 days (P=0.023), and lesion diameter >15 mm (P=0.004). Multivariable analysis revealed independent predictors of procedure-related bleeding: age above 65 years [odds ratio (OR) 2.14, P=0.044], antiplatelet use within 5 days (OR 2.42, P=0.047), right colon polyp (OR 3.51, P=0.001), and lesion diameter >15 mm (OR 3.22, P=0.003). EMR in cirrhotics has an acceptable bleeding risk. Age above 65 years, right colon polyp, polyp size >15 mm, and use of antiplatelets within 5 days are independent risk factors for bleeding.

Mo1769 RISK FACTORS ASSOCIATED WITH POST-ENDOSCOPIC MUCOSAL RESECTION BLEEDING IN PATIENTS WITH CIRRHOSIS: A RETROSPECTIVE MULTICENTER COHORT STUDY

Cirrhotic patients are at an increased risk of bleeding and malignancy due to the inherent nature of the disease. Endoscopic therapeutic procedures have become widespread in recent years, but there is a lack of data regarding the safety of endoscopic mucosal resection (EMR) in the cirrhotic population. Our study aimed to evaluate the safety of colonoscopic EMR in patients with cirrhosis. A retrospective review of patients with cirrhosis who underwent colonoscopic EMR at eight different centers between January 1, 2006, and December 31, 2018, was performed. Patient characteristics, medications, the severity of liver disease, procedural details, and polyp data were collected. Complications such as immediate bleeding, delayed bleeding, post-polypectomy syndrome (PPS), hospitalization, perforation, and death were recorded for 30 days after the procedure. Patients were excluded if they had a history of a prior liver transplant, concurrent metastatic malignancy, and hematological or coagulation disorders. Chi-square analysis were performed for dichotomous variables, Mantel-Haenszel trend tests for ordinal variables, and Fisher’s exact tests were used when expected cell frequencies were below 5.0. Patients’ age was compared using independent t-tests. A total of 275 EMRs in 258 patients satisfied the inclusion criteria. The baseline clinical characteristics of the patients are presented in Table 1. Immediate, delayed and PPS complication rates due to the procedure were 9.1%, 5.5%, and 1.1%, respectively. There were 2 deaths unrelated to the EMR within 30 days of the procedure; one patient died from variceal bleeding and the other from sepsis of unknown origin. Twenty-six patients (9.6%) were hospitalized. Ten patients (3.7%) required blood transfusions and 9 patients (3.3%) underwent a repeat colonoscopy. The univariate analysis showed that risk factors for post-polypectomy bleeding were age over 65 (p < 0.01), procedure duration greater than 37 minutes (p < 0.01), antiplatelet use within 5 days (p = 0.02), lesion diameter >10 mm (p = 0.03) and polyp location in cecum (p <0.01). Multivariate regression analysis (Table 2) revealed the following independent predictors of procedure-related bleeding: age over 65 (OR:2.30, 95% CI:1.09-4.82, p = 0.028), antiplatelet use within 5 days (OR 2.42, 95%CI 1.01-5.80 p = 0.047), polyp location in the cecum (OR 3.26, 95%CI 1.52-6.97. p = 0.002) and lesion diameter >10 mm (OR:2.37, 95% CI:1.09-5.17, p = 0.030). The results of our study show that EMR in cirrhotic patients has a low risk of major complications. Age greater than 65, EMR performed in the cecum, polyp size >10 mm, and use of antiplatelets within 5 days are independent risk factors for bleeding. Further prospective studies are needed in a larger cohort of patients to confirm our findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

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.

Bridge Therapy with Heparin Is the Largest Risk Factor for Postpolypectomy Bleeding

Risk factors for delayed postpolypectomy hemorrhage include increasing polyp size, proximal colon location, and use of anticoagulation or

Risk factors for postpolypectomy bleeding in patients receiving anticoagulation or antiplatelet medications

Balancing the risks for thromboembolism and postpolypectomy bleeding in patients requiring anticoagulation and antiplatelet agents is challenging. We investigated the incidence and risk factors for postpolypectomy bleeding on anticoagulation, including heparin bridge and other antithrombotic therapy. We performed a retrospective cohort and case control study at 2 tertiary-care medical centers from 2004 to 2012. Cases included male patients on antithrombotics with hematochezia after polypectomy. Nonbleeding controls were matched to cases 3 to 1 by antithrombotic type, study site, polypectomy technique, and year of procedure. Our outcomes were the incidence and risk factors for postpolypectomy bleeding. There were 59 cases and 174 matched controls. Postpolypectomy bleeding occurred in 14.9% on bridge anticoagulation. This was significantly higher than the overall incidence of bleeding on antithrombotics at 1.19% (95% confidence interval, 0.91%-1.54%) (59/4923). We identified similarly low rates of bleeding in patients taking warfarin (0.66%), clopidogrel (0.84%), and aspirin (0.92%). Patients who bled tended to have larger polyps (13.9 vs 7.3mm; P< .001) and more polyps≥2 cm (41% vs 10%; P< .001). Bleeding risk was increased with restarting antithrombotics within 1 week postpolypectomy (odds ratio [OR] 4.50; P< .001), having polyps≥2 cm (OR 5.94; P< .001), performing right-sided cautery (OR 2.61; P= .004), and having multiple large polyps (OR 2.92; P=.001). Among patients on warfarin, the presence of bridge anticoagulation was an independent risk factor for postpolypectomy bleeding (OR 12.27; P= .0001). We conclude that bridge anticoagulation is associated with a high incidence of postpolypectomy bleeding and is an independent risk factor for hemorrhage compared with patients taking warfarin alone. A higher threshold to use bridge anticoagulation should be considered in patients with an elevated bleeding risk.

Analysis of Predictive Factors for Complications and Complete Histological Eradication of Cold Snare Polypectomy in Colonoscopy

Introduction: Colorectal cancer (CRC) is a major cause of morbidity and mortality in Western countries and also in Japan. Colonoscopy is associated with a reduced incidence of CRC, and colonoscopic removal of adenomatous polyps results in the prevention of death from CRC. Endoscopic polypectomy carries a definite risk for complications, such as bleeding or perforation. Recently, the high safety and efficacy of cold snare polypectomy (CSP) has been reported, however, the evaluation of factors associated with safety and efficacy of CSP is deficit. The aim of this study is to elucidate the predictive factors of complications and complete histological eradication of polyp. Methods: We retrospectively reviewed the colonoscopic database of patients who underwent CSP between December 2013 to November 2014 in terms of patient's characteristics, location, size, macroscopic appearance of each colorectal polyp, narrow band imaging with magnification (NBI-M), and endoscopist's experience. CSP were performed by 21 endoscopists consisted of 8 experts and 13 trainee. CSP were indicated for polyps presenting at colonoscopy with at least < 10-mm polyp. Univariate and multivariate analysis were performed to reveal the predictive factors associated with complications and complete histological eradication. Results: A total of 399 polyps in 216 patients without antithrombotics were removed. Of these, 355 polyps (89%) were ≤ 5 mm and 175 polyps (44%) were protruding lesions. Failure of tissue retrieval was noted in 3% of resected polyps. There was no intramucosal carcinoma. Colonoscopy with NBI-M was performed for 75 polyps (19%). Although immediate bleeding or hematochezia after procedure occurred in 30 polyps (7.5%) of 21 patients (9.7%), no delayed bleeding or perforation was observed. At multivariate analysis, protruded lesion was an independent risk factor associated with post-polypectomy bleeding (odds ratio [OR] 2.5; 95%CI 1.12-5.56). The overall rate of complete histological polyp eradication was obtained in 139 polyps (35%). Multivariate analysis elucidated that the observation of the polyp with NBI-M was an independent predictor associated with complete histological eradication (OR 2.27; 95%CI 1.36-3.78). Conclusion: CSP is a safe and effective technique for small and diminutive polyps. Macroscopic protruding appearance of polyp is a risk factor for post-polypectomy bleeding. A higher rate of complete histological eradication with CSP can be achieved by colonoscopy with NBI-M than with white-light imaging.

Heparin bridge therapy and post-polypectomy bleeding.

AIMTo identify risk factors for post-polypectomy bleeding (PPB), focusing on antithrombotic agents.METHODSThis was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed.RESULTSPPB occurred in 29 (3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210 (26.6%) patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB (P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB (P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant.CONCLUSIONPatients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.

Are selective serotonin reuptake inhibitors (SSRIs) a risk factor for post-polypectomy bleeding?

Are selective serotonin reuptake inhibitors (SSRIs) a risk factor for post-polypectomy bleeding?

Tu1505 Endoscopic Prevention of Postpolypectomy Bleeding in Large Pedunculated Colorectal Polyps: Single Method (Clipping Only) Versus Combined Method (Clipping Plus Epinephrine Injection)

Post-polypectomy bleeding (PPB) is the most common complication of colonoscopic polypectomy, accounting for 0.3 to 6.1 percent of polypectomy. Especially, pedunculated polyp is known to be a risk factor for PPB. The aim of the present study is to compare the rate of PPB in large pedunculated polyps with prophylactic clipping with that with prophylactic clipping plus epinephrine injection.

Bleeding Risk after Invasive Procedures in Aspirin/NSAID Users: Polypectomy Study in Veterans

BackgroundAspirin, by virtue of inhibition of platelet hemostatic function, is withheld before many invasive procedures because of the bleeding risk. American Society of Gastrointestinal Endoscopy guidelines acknowledge the paucity of “high quality data” to make recommendations regarding the use of aspirin (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs) before endoscopic procedures. Yet the majority of endoscopists hold ASA/NSAIDs before polypectomy. MethodsThis single-center, retrospective, cohort study was conducted at Veterans Affairs Medical Center, Syracuse, NY. The objectives were to assess the postpolypectomy bleeding risk in ASA/NSAID users in a large cohort of veterans undergoing colonoscopic polypectomy and to identify risk factors associated with postpolypectomy bleeding. All patients undergoing polypectomy between January 2002 and October 2007 were eligible. Patients on anticoagulants/other antiplatelet agents were excluded. Patients were selected randomly by cluster sampling techniques. Electronic medical and pharmacy records were reviewed for patient demographics, polypectomy techniques, and postpolypectomy bleeding rates. Univariate analysis was performed between patients on ASA and NSAIDs (group A) versus those not on ASA or NSAIDs (group B). Multiple regression analysis was performed to identify independent risk factors associated with postpolypectomy bleeding. ResultsFive hundred two (43%) of 1174 patients (mean age 66 years, 92% white) were on ASA or NSAIDs, or both. There was no significant difference between postpolypectomy bleeding rates among the 2 groups (3.2% vs 3.0%). Age, sex, polyp characteristics, and polypectomy techniques were comparable between groups A and B. In multiple logistic regression analysis, ASA or NSAID use was not a significant risk factor for postpolypectomy bleeding. Number of polyps removed per patient was the only risk factor significantly associated with postpolypectomy bleeding (P <.01, odds ratio 1.3, 95% confidence interval, 1.18-1.43). ConclusionsIn this large study, use of ASA or NSAIDs did not increase the risk of postpolypectomy bleeding. Cessation of ASA/NSAIDs before colonoscopy/polypectomy is therefore unnecessary.

Incidence and predictors of postpolypectomy bleeding in colorectal polyps larger than 10 mm

It is well-established that the risk of postpolypectomy bleeding (PPB) increases with polyp size, but little is known about the factors that predict PPB in polyps larger than 10 mm. The aim of this study is to assess the incidence and risk factors for PPB in colorectal polyps larger than 10 mm. A historical cohort study was carried out in an open access endoscopy unit from January 2007 to December 2008. Endoscopic polypectomy was performed in 1894 (28%) patients. Clinical records of patients with polyps of at least 10 mm were reviewed. Data on demographics, comorbidity, polyp-related features, and resection technique were collected. The incidence of immediate bleeding (during polypectomy) and delayed bleeding (up to 1 month later) was assessed. A total of 424 large polyps (median size=12 mm; P₂₅-P₇₅: 10-16 mm) were resected. Thirty-five episodes of PPB occurred in 33 (7.8%) polyps, of which 12 (2.8%) were delayed. Multivariate logistic regression analysis demonstrated that a polyp size of at least 14 mm was the most important predictor of PPB [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.492-6.751, P=0.003], compared with the presence of a villous architecture (OR 2.23, 95% CI 1.056-4.705, P=0.035) or high-grade dysplasia (OR 2.96, 95% CI 1.305-6.692, P=0.009). In the current study, the rate of PPB was almost 8% in polyps larger than 10 mm, occurring in most cases during the endoscopic procedure. A polyp of size at least 14 mm was the most important predictor for PPB. Prospective studies are needed to determine whether preventive endoscopic therapy may reduce PPB in these patients.

Analysis about risk factors of Postpolypectomy bleeding

Analysis about risk factors of Postpolypectomy bleeding

Endoscopic Ultrasound (EUS) Before Gastric Polyp Resection

Gastric polypectomy is associated with increased risk of bleeding. The use of endoscopic ultrasound (EUS) before polypectomy to decrease the rate of bleeding in such patients has not been studied. All gastric polyps excised by snare polypectomy were evaluated. The primary outcome was the occurrence of immediate or delayed bleeding episodes. Postpolypectomy bleeding was correlated with the presence of blood vessels at the base of the polyp on EUS examination. Characteristics of both patients and polyps were analyzed as risk factors for postpolypectomy bleeding. One-hundred and two snare polypectomies were performed. Fifty-seven polyps (56%) had been evaluated by prior EUS. Bleeding occurred in 7 (7%) patients. Of these, 4 had not undergone EUS evaluation, whereas in 3 patients who had had a prepolypectomy EUS evaluation, none were found to harbor a visible blood vessel. Bleeding did not occur in any of the 8 patients in whom EUS suggested the presence of blood vessel. The size, location, type, and histology did not show any significance in predicting postpolypectomy bleeding. The risk of bleeding after endoscopic resection of gastric polyps was 7%. EUS evaluation before gastric polypectomy does not seem to contribute to the safety of such a procedure.