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Only the Size of Resected Polyps Is an Independent Risk Factor for Delayed Postpolypectomy Hemorrhage: A 10-Year Single-Center Case-Control Study: Hee Seok Moon, Sun Wook Park, Dong Hwan Kim, Sun Hyung Kang, Jae Kyu Sung, Hyun Yong Jeong; Ann Coloproctol. 2014;30(4):182-185. Published online August 26, 2014; DOI: https://doi.org/10.3393/ac.2014.30.4.182

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Purpose

A colonoscopic polypectomy is an important procedure for preventing colorectal cancer, but it is not free from complications. Delayed hemorrhage after a colonoscopic polypectomy is one infrequent, but serious, complication. The aim of this study was to identify the risk factors for delayed hemorrhage after a colonoscopic polypectomy.

Methods

This was a retrospective case-control study based on medical records from a single gastroenterology center. The records of 7,217 patients who underwent a colonoscopic polypectomy between March 2002 and March 2012 were reviewed, and 92 patients and 276 controls were selected. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, resection method, and use of prophylactic hemostasis.

Results

The average time between the procedure and bleeding was 2.71 ± 1.55 days. Univariate and multivariate analyses revealed that the size of the polyps was the only and most important predictor of delayed hemorrhage after a colonoscopic polypectomy (odds ratio, 2.06; 95% confidence interval, 1.12-1.27; P = 0.03).

Conclusion

The size of resected polyps was the only independent risk factor for delayed bleeding after a colonoscopic polypectomy. The size of a polyp, as revealed by the colonoscopic procedure, may aid in making decisions, such as the decision to conduct a prophylactic hemostatic procedure.

Citations

Citations to this article as recorded by

Complete closure utilizing titanium clips minimizes delayed postpolypectomy bleeding after colorectal endoscopic mucosal resection: a retrospective analysis
Wei-Feng Li, Bing Lai, Li Lv, Xi-Qiu Yu, Jia-Le Fan, Zhi-Wei Zhou, Jing-Wen Xu, Ruo-Yu Gao, Ze-Ming Chen, Bi-Xia Xu
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Risk factors for delayed colorectal postpolypectomy bleeding: a meta-analysis
Xuzhen Zhang, Xiaoxing Jiang, Liang Shi
BMC Gastroenterology.2024;[Epub] CrossRef
Risk factors of delayed post-polypectomy bleeding after treatment of gastrointestinal polyps with snare-assisted endoscopic sub-mucosal dissection
Xiuyan Lu, Ji Ma
Journal of Minimal Access Surgery.2023; 19(2): 272. CrossRef
Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps: two or more clips may be safe
Xue-Feng Guo, Xiang-An Yu, Jian-Cong Hu, De-Zheng Lin, Jia-Xin Deng, Ming-Li Su, Juan Li, Wei Liu, Jia-Wei Zhang, Qing-Hua Zhong
Gastroenterology Report.2022;[Epub] CrossRef
Blood group O is a risk factor for delayed post-polypectomy bleeding
Hiroto Furuhashi, Akira Dobashi, Naoto Tamai, Nana Shimamoto, Masakuni Kobayashi, Shingo Ono, Yuko Hara, Hiroaki Matsui, Shunsuke Kamba, Hideka Horiuchi, Akio Koizumi, Tomohiko R. Ohya, Masayuki Kato, Keiichi Ikeda, Hiroshi Arakawa, Kazuki Sumiyama
Surgical Endoscopy.2021; 35(12): 6882. CrossRef
Prophylactic clip application for large pedunculated polyps before snare polypectomy may decrease immediate postpolypectomy bleeding
Jae Seung Soh, Myeongsook Seo, Kyung-Jo Kim
BMC Gastroenterology.2020;[Epub] CrossRef
Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Hyun Lim, Eun Jeong Gong, Byung-Hoon Min, Seung Joo Kang, Cheol Min Shin, Jeong-Sik Byeon, Miyoung Choi, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun
Clinical Endoscopy.2020; 53(6): 663. CrossRef
Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Hyun Lim, Eun Jeong Gong, Byung-Hoon Min, Seung Joo Kang, Cheol Min Shin, Jeong-Sik Byeon, Miyoung Choi, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun
The Korean Journal of Gastroenterology.2020; 76(6): 282. CrossRef
Risk factors for delayed hemorrhage after colonoscopic postpolypectomy: Polyp size and operative modality
Changqin Liu, Ruijin Wu, Xiaomin Sun, Chunhua Tao, Zhanju Liu
JGH Open.2019; 3(1): 61. CrossRef
Adverse events related to colonoscopy: Global trends and future challenges
Su Young Kim, Hyun-Soo Kim, Hong Jun Park
World Journal of Gastroenterology.2019; 25(2): 190. CrossRef
Complications Following Colonoscopy in a Nationwide Standard Cohort: A Retrospective Case-control Study
Ji Woo Kim, Su Young Kim, Jung Hye Choi, Hyun-Soo Kim, Jung Kuk Lee, Yun Tae Kim, Geunu Park, Dae Ryong Kang
The Korean Journal of Gastroenterology.2019; 73(3): 152. CrossRef
Post-polypectomy bleeding after colonoscopy on uninterrupted aspirin/non steroideal antiflammatory drugs: Systematic review and meta-analysis
Flavia Pigò, Helga Bertani, Giuseppe Grande, Federica Abate, Sara Vavassori, Rita Luisa Conigliaro
Digestive and Liver Disease.2018; 50(1): 20. CrossRef
Management of complex polyps of the colon and rectum
Fernando A. Angarita, Adina E. Feinberg, Stanley M. Feinberg, Robert H. Riddell, J. Andrea McCart
International Journal of Colorectal Disease.2018; 33(2): 115. CrossRef
Prospective analysis of delayed colorectal post-polypectomy bleeding
Soo-Kyung Park, Jeong Yeon Seo, Min-Gu Lee, Hyo-Joon Yang, Yoon Suk Jung, Kyu Yong Choi, Hungdai Kim, Hyung Ook Kim, Kyung Uk Jung, Ho-Kyung Chun, Dong Il Park
Surgical Endoscopy.2018; 32(7): 3282. CrossRef
Current strategies for malignant pedunculated colorectal polyps
Adriana Ciocalteu, Dan Ionut Gheonea, Adrian Saftoiu, Liliana Streba, Nicoleta Alice Dragoescu, Tiberiu Stefanita Tenea-Cojan
World Journal of Gastrointestinal Oncology.2018; 10(12): 465. CrossRef
Risk factors for delayed colonic post-polypectomy bleeding: a systematic review and meta-analysis
Veeravich Jaruvongvanich, Narut Prasitlumkum, Buravej Assavapongpaiboon, Sakolwan Suchartlikitwong, Anawin Sanguankeo, Sikarin Upala
International Journal of Colorectal Disease.2017; 32(10): 1399. CrossRef
Abdominal wall abscess secondary to colonoscopic polypectomy. Radiological management
María Luisa García-García, Miguel Ángel Jiménez-Ballester, Enrique Girela-Baena, José Luis Aguayo-Albasini
Gastroenterología y Hepatología (English Edition).2017; 40(7): 463. CrossRef
Polyp Resection - Controversial Practices and Unanswered Questions
Daniel von Renteln, Heiko Pohl
Clinical and Translational Gastroenterology.2017; 8(3): e76. CrossRef
Colección abscesificada en pared abdominal secundaria a polipectomía colonoscópica. Manejo radiológico
María Luisa García-García, Miguel Ángel Jiménez-Ballester, Enrique Girela-Baena, José Luis Aguayo-Albasini
Gastroenterología y Hepatología.2017; 40(7): 463. CrossRef
Efficacy and adverse events of coldvshot polypectomy: A meta-analysis
Mikihiro Fujiya, Hiroki Sato, Nobuhiro Ueno, Aki Sakatani, Kazuyuki Tanaka, Tatsuya Dokoshi, Shugo Fujibayashi, Yoshiki Nomura, Shin Kashima, Takuma Gotoh, Junpei Sasajima, Kentaro Moriichi, Jiro Watari, Yutaka Kohgo
World Journal of Gastroenterology.2016; 22(23): 5436. CrossRef
Post-Colonoscopy Complications: A Systematic Review, Time Trends, and Meta-Analysis of Population-Based Studies
Ankie Reumkens, Eveline J A Rondagh, Minke C Bakker, Bjorn Winkens, Ad A M Masclee, Silvia Sanduleanu
American Journal of Gastroenterology.2016; 111(8): 1092. CrossRef
Systematic review with meta-analysis: the risk of gastrointestinal haemorrhage post-polypectomy in patients receiving anti-platelet, anti-coagulant and/or thienopyridine medications
D. Shalman, L. B. Gerson
Alimentary Pharmacology & Therapeutics.2015; 42(8): 949. CrossRef
Prediction and Prevention of Postpolypectomy Bleeding: Current Challenging Issues
Duck-Woo Kim
Annals of Coloproctology.2014; 30(4): 157. CrossRef

A Survey of Colonoscopic Surveillance After Polypectomy: Dae Kyung Sohn; Ann Coloproctol. 2014;30(2):88-92. Published online April 25, 2014; DOI: https://doi.org/10.3393/ac.2014.30.2.88

6,989 View
43 Download
9 Web of Science
7 Citations

Abstract PDF

Purpose

Several guidelines have been proposed for surveillance colonoscopy after polypectomy. However, some discrepancies still exist between the guidelines and clinical practice. This study was conducted to identify Korean doctors' recommendations for the colonoscopic surveillance interval after polypectomy.

Methods

A survey of the attendees at the symposium of the 64th Annual Congress of the Korean Surgical Society was conducted. When the prepared clinical scenarios were given, attendees answered using a wireless radio-frequency audience response system. All responders' results were automatically counted immediately. Frequencies of different answers to each question were calculated, and our results were compared with those of previous surveys performed using the same questionnaire in the United States or Japan.

Results

The number of responder varied from 38 to 41. About 50% of valid responders selected 'follow-up in 3 years' for low-risk lesions, such as a 6-mm hyperplastic polyp, a 6-mm tubular adenoma, or two 6-mm tubular adenomas. Responders most-commonly selected 'follow-up in 1 year' for high-risk lesions, such as a 12-mm tubular adenoma with high grade dysplasia or a 12-mm tubulovillous adenoma. The majority of Korean doctors recommend postpolypectomy colonoscopic surveillance more frequently than American physicians did.

Conclusion

A discrepancy between the guidelines and clinical practice for the surveillance after polypectomy still exists in Korea. A surveillance program that can be easily and widely applied in clinical practice needs to be established.

Citations

Citations to this article as recorded by

Analysis of adenoma detection rate of colonoscopy among trainees
Young Min Song, Kyung Su Han, Byung Chang Kim, Chang Won Hong, Bun Kim, Min Chul Kim, Myeong Jae Jin, Dae Kyung Sohn
Annals of Coloproctology.2024; 40(6): 548. CrossRef
Adherence to Surveillance Guidelines after the Removal of Colorectal Polyps: A Multinational, Multicenter, Prospective Survey
Chang Kyo Oh, Satimai Aniwan, Panida Piyachaturawat, Zhiqin Wong, Thida Soe, Bayasgalan Luvsandagva, Quang Trung Tran, Achmad Fauzi, Jeong-Sik Byeon, Young-Seok Cho
Gut and Liver.2021; 15(6): 878. CrossRef
The current capacity and quality of colonoscopy in Korea
Jae Ho Choi, Jae Myung Cha, Jin Young Yoon, Min Seob Kwak, Jung Won Jeon, Hyun Phil Shin
Intestinal Research.2019; 17(1): 119. CrossRef
Guideline Adherence to Colonoscopic Surveillance Intervals after Polypectomy in Korea: Results from a Nationwide Survey
Seri Hong, Mina Suh, Kui Son Choi, Boyoung Park, Jae Myung Cha, Hyun-Soo Kim, Jae Kwan Jun, Dong Soo Han
Gut and Liver.2018; 12(4): 426. CrossRef
Determining the optimal surveillance interval after a colonoscopic polypectomy for the Korean population?
Jung Lok Lee, Jae Myung Cha, Hye Min Lee, Jung Won Jeon, Min Seob Kwak, Jin Young Yoon, Hyun Phil Shin, Kwang Ro Joo, Joung Il Lee, Dong Il Park
Intestinal Research.2017; 15(1): 109. CrossRef
Factors Associated With Shorter Colonoscopy Surveillance Intervals for Patients With Low-Risk Colorectal Adenomas and Effects on Outcome
Joseph C. Anderson, John A. Baron, Dennis J. Ahnen, Elizabeth L. Barry, Roberd M. Bostick, Carol A. Burke, Robert S. Bresalier, Timothy R. Church, Bernard F. Cole, Marcia Cruz-Correa, Adam S. Kim, Leila A. Mott, Robert S. Sandler, Douglas J. Robertson
Gastroenterology.2017; 152(8): 1933. CrossRef
Association Between Exposure to Environmental Tobacco Smoke at the Workplace and Risk for Developing a Colorectal Adenoma: A Cross-Sectional Study
Seung-Hwa Lee, Ji-Yeon Hong, Jung-Un Lee, Dong Ryul Lee
Annals of Coloproctology.2016; 32(2): 51. CrossRef

Delayed Bleeding in a Colonoscopic Polypectomy: An experience with 5,236 polypectomies.: Kim, Hyun Shig , Kim, Kuhn Uk , Park, Weon Kap , Cho, Kyung A , Hwang, Do Yean , Kang, Yong Won , Yoon, Seo Gue , Lee, Kwang Real , Lee, Jong Kyun , Kim, Kwang Yun; J Korean Soc Coloproctol. 2000;16(6):462-468.

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Abstract PDF: PURPOSE
Delayed hemorrhage rarely happens after a colonoscopic polypectomy, ranging from 0.2 to 1.8% in frequency. Although its occurrence is unpredictable and it may be serious in some cases, scanty data on its causes, characteristics, and effective management exist in Korea. This study was conducted to provide such data, especially data on the characteristics of delayed hemorrhage and its effective management.
METHODS
From 1997 to 1999, one endoscopist at Song-Do Colorectal Hospital performed 5236 polypectomies on 2511 patients. Delayed hemorrhage occurred after 9 of those polypectomies, for a bleeding incidence rate of 0.17% (9/5236). The authors reviewed those 9 incidence of delayed hemorrhage, which involved 9 patients and 9 lesions, with emphasis on the characteristics of the bleeding and the treatment.
RESULTS
The mean age of the 9 patients was 50 years, and the male-to-female ratio was 8: 1. The sigmoid colon was involved in 4 of those patients (44.4%), and the right-sided colon was involved in another 4 of those patients. Lesions smaller than 11 mm were either sessile or flat-elevated and accounted for 6 of the 9 lesions (66.7%). The remaning lesions, which were larger than 10 mm, were either pedunculated or semipedunculated. Three (3) of the 9 patients (33.3%) experienced bleeding on day 1, the most common bleeding day. Another 5 patients (55.6%) experienced bleeding during the next 4 days (days 2 to 5). The last patient experienced bleeding on day 9, the latest bleeding day. A snare polypectomy had been performed on 7 of the 9 patients (77.8%), and a hot biopsy had been performed on the other 2 (22.2%). All delayed bleeding was treated by using hemoclips; additional epinephrine injection was used in 55.6% of the cases and an additional detachable snare in 22.2%. Rebleeding was noticed the day following the initial treatment of bleeding in one case and was managed by using hemoclips.
CONCLUSIONS
The first 5 days after a colonoscopic polypectomy are crucial, and caution is required during the next 5 days. Thorough knowledge about preventing and managing bleeding is essential.

Rectal Carcinoid: Effectiveness of Endoscopic Resection.: Park, Weon Kap , Kim, Hyun Shig , Cho, Kyung A , Hwang, Do Yeon , Kim, Kuhn Uk , Kang, Yong Won , Yoon, Seo Gue , Lee, Kwang Real , Lee, Jong Kyun , Lee, Jung Dal , Kim, Kwang Yun; J Korean Soc Coloproctol. 2000;16(2):109-114.

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Abstract PDF: PURPOSE
Small-sized carcinoids, less than 1 cm, are easily detected using flexible sigmoidoscopy or total colonoscopy and can be treated by local excision. Recently, there has been many advances in the technique of endoscopic resection. The aim of this study was to determine the endoscopic findings of a rectal carcinoid and to evaluate the effectiveness of endoscopic resection.
METHODS
We experienced 22 rectal carcinoids in 21 patients who were treated by endoscopic resection from June 1996 to February 1999. Nineteen cases were followed for an average of 21 months. Follow-up studies consisted of chest P-A, hepatic ultrasonography, and total colonoscopy.
RESULTS
The male-to-female ratio was 1.6 to 1. The most common age group was the 4th decade. The tumor was located at the lower rectum in 10 patients, at the upper rectum in 10 patients, and at the rectosigmoid junction in 2 patients. The tumor sizes ranged from 3 to 12 mm in diameter and were smaller than 10 mm in 20 cases (90.1%). Endoscopic finding revealed that the tumors were covered by a normally appearing mucosa in 12 cases, were yellow-discolored polyps in 17 cases, and were sessile-type tumors in 19 cases. The method of treatment was an endoscopic mucosal resection (EMR, 14 cases) or a snare polypectomy (8 cases). Microscopically positive margins were noticed in four cases, two cases of EMR (2/14, 14%) and two cases of snare polypectomy (2/8, 25%). All the patients were alive and clinically free of disease; however, the duration of the follow-up is short.
CONCLUSIONS
Endoscopic resection for rectal carcinoid tumors smaller than 1 cm in diameter is a safe, functional, time-saving, and effective treatment. If the tumor suggests a carcinoid, EMR is advised rather than a polypectomy even though the tumor is small. Microscopically positive margins are not absolute indications for further surgery in the treatment of carcinoids smaller than 1 cm in diameter. It is much more important for an endoscopist to be confident that the endoscopic resection is done completely. It is necessary to identify the factors influencing the malignancy potential and to have a longer follow-up.

Review

Difficult Polypectomy.: Kim, Hyun Shig; J Korean Soc Coloproctol. 2003;19(6):399-405.

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Abstract PDF: No abstract available.

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