Background and Aims
Postpolypectomy bleeding is the most common adverse event with pedunculated polyps.
We clarified the endoscopic characteristics influencing postpolypectomy bleeding for
pedunculated colonic polyps.
Methods
We reviewed clinical data for 1147 pedunculated colonic polyps removed by polypectomy
in 5 Japanese institutions. Pedunculated polyps were defined as polyps with a stalk
length ≥5 mm. Analyzed clinical data were age, sex, polyp location/size, stalk length/width,
prophylactic clipping or endoloop before polypectomy, injecting the stalk, closing
the polypectomy site, antithrombotic agent use, and endoscopist experience. Postpolypectomy
bleeding was classified as immediate bleeding or delayed bleeding.
Results
Immediate and delayed bleeding was observed in 8.5% (97/1147) and 2% (23/1147) of
polypectomies, respectively. Comparing immediate bleeding with nonbleeding, multivariate
analysis showed that stalk width ≥6 mm (odds ratio [OR], 1.9; 95% confidence interval
[CI], 1.1-3.4) was a significant risk factor for immediate bleeding. For polyp size ≥15 mm,
prophylactic endoloop use (OR, .17; 95% CI, .04-.72) was a significant inhibiting
factor. Comparing delayed bleeding with nonbleeding, multivariate analysis showed
that prophylactic clipping before polypectomy (OR, 4.2; 95% CI, 1.3-13) and injecting
the stalk (OR, 4.0; 95% CI, 1.4-12) were significant risk factors for delayed bleeding.
Conclusions
The increased risk for delayed bleeding with injecting the stalk and prophylactic
clipping before polypectomy suggests that simple resection with coagulation mode is
a suitable strategy in endoscopic resection of pedunculated polyps. Moreover, prophylactic
endoloop use was highly likely to inhibit immediate bleeding with polyp size ≥15 mm.
Abbreviations:
CI (confidence interval), OR (odds ratio), RCT (randomized controlled trial)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.N Engl J Med. 1993; 329: 1977-1981
- Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.N Engl J Med. 2012; 366: 687-696
- Colorectal cancer screening, version 1.2015.J Natl Compr Canc Netw. 2015; 13 (quiz 68): 959-968
- Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer.World J Surg. 2000; 24: 1081-1090
- Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study.Surg Endosc. 2009; 23: 2732-2737
- Endo-loop in the prevention of the post-polypectomy bleeding: preliminary results.Gastrointest Endosc. 1997; 46: 387-389
- Comparison of prophylactic clip and endoloop application for the prevention of postpolypectomy bleeding in pedunculated colonic polyps: a prospective, randomized, multicenter study.Endoscopy. 2014; 46: 598-604
- Comparison of clipping with and without epinephrine injection for the prevention of post-polypectomy bleeding in pedunculated colon polyps.J Gastroenterol Hepatol. 2015; 30: 1499-1506
- Endoscopic resection of large pedunculated colorectal polyps using a detachable snare.Gastrointest Endosc. 1996; 44: 594-597
- Prophylactic clip application for large pedunculated polyps before snare polypectomy may decrease immediate postpolypectomy bleeding.BMC Gastroenterol. 2020; 20: 68
- Effect of prophylactic clip application for the prevention of postpolypectomy bleeding of large pedunculated colonic polyps: a randomized controlled trial.Gastrointest Endosc. 2021; 94: 148-154
- JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection.Dig Endosc. 2015; 27: 417-434
- Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment.Dig Endosc. 2014; 26: 1-14
- Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors.Gastrointest Endosc. 2006; 64: 73-78
- Incidence and risk factors of delayed postpolypectomy bleeding: a retrospective cohort study.J Clin Gastroenterol. 2014; 48: 784-789
- Hemorrhage following colonoscopic polypectomy.Dis Colon Rectum. 1993; 36: 1126-1131
- Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions.Gastrointest Endosc. 2013; 77: 401-407
- Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy.Gastrointest Endosc. 2003; 57: 691-694
- Risk factors for delayed bleeding after endoscopic resection for large colorectal tumors.Jpn J Clin Oncol. 2012; 42: 1028-1034
- Is the use of prophylactic hemoclips in the endoscopic resection of large pedunculated polyps useful? A prospective and randomized study.J Interv Gastroenterol. 2012; 2: 99-104
- Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy.Gastrointest Endosc. 2006; 63: 1004-1009
- Risk factors for delayed post-polypectomy bleeding.Intest Res. 2015; 13: 160-165
- A randomized study on the effectiveness of prophylactic clipping during endoscopic resection of colon polyps for the prevention of delayed bleeding.Biomed Res Int. Epub 2015 Feb 3;
- Risk factors for adverse events related to polypectomy in the English Bowel Cancer Screening Programme.Endoscopy. 2014; 46: 90-97
- Complications of colonoscopy.Gastrointest Endosc. 2011; 74: 745-752
- Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study.Hepatogastroenterology. 2001; 48: 1379-1382
- Comparison of efficacy of prophylactic endoscopic therapies for postpolypectomy bleeding in the colorectum: a systematic review and network meta-analysis.Am J Gastroenterol. 2016; 111: 1230-1243
- Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution.Am J Gastroenterol. 1994; 89: 334-338
- Measurement of tissue water content of rat kidneys using bioelectrical impedance technique.Jpn J Artif Organs. 1993; 22: 999-1003
- Cold polypectomy techniques for diminutive polyps in the colorectum.Dig Endosc. 2014; 26: 98-103
- Safety of cold polypectomy for <10 mm polyps at colonoscopy: a prospective multicenter study.Endoscopy. 2012; 44: 27-31
- Endoscopic removal of colorectal lesions—recommendations by the US Multi-Society Task Force on Colorectal Cancer.Gastroenterology. 2020; 158: 1095-1129
Article info
Publication history
Published online: April 12, 2021
Accepted:
March 30,
2021
Received:
January 19,
2021
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Research support for this study was provided by a grant from JSPS KAKENHI (no. 18K07925).
See CME section; p. 849.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
