Risk Factors for Colorectal Postpolypectomy and Emr Bleeding: A Prospective Cohort Study

Aims Endoscopic polypectomy is at the forefront of colorectal cancer (CRC) prevention. However, endoscopic polypectomy is not completely free of complications, with bleeding being one of the most common complications encountered. Addressing the issue of colonoscopic complications, and postpolypectomy bleeding (PPB) in particular is becoming more important. Despite the fact that the overall incidence of PPB is low, predisposing factors need to be elucidated to further decrease the frequency of this complication. Furthermore, the role of various techniques of PPB prophylaxis remains controversial.

Methods We performed a prospective endoscopic observational trial focusing in the rate of acute and delayed postinterventional bleeding after endoscopic resection of colorectal adenomatous lesions. Enrollment of patients was from 01.01.2015 until 30.06.2020. Patient-related, polyp/lesion-related and procedure-related factors were evaluated for PPB.

Results Overall, 480pts. (222 female/258 male) were included and analyzed. Median age was 70 +/-11.6 years. Location of lesions are as follows: right hemicolon 46 %, transverse 16 %, left hemicolon 27 %, rectum 11 %. Mean size of the lesion was 19 +/-12.8mm. Anticoagulation therapy was taken by 15 % of cases. Endoscopic resection technique was en-bloc snare polypectomy 58 %, piece meal EMR 29 %, ESD 12 % and FTRD 1 %. Bleeding occurred in 55/480 (12 %) of cases, severe bleeding in 2 %. Hemostatic therapy comprises injection 50/55, Clipping 45/55, Hot-biopsy 15/55, APC 18/55 and combination of therapy. Anticoagulation/antiplateled therapy, right-sided location and peace-meal EMR were strong risk factors for PPB (OR 2.58). Transfusion was required in 16/55of pts.

Conclusions Lesion size, right-hemicolon location and anticoagulation therapy were identified as strong risk factors for PPB. Technical related-factors like type of HF-current, type of snare as well as type and volume of submucosal cushioning may also interfere and influence PPB but this has to be studied in detail in further studies.

Citation: Harel G, Genthner A, Straulino F et al. eP227 RISK FACTORS FOR COLORECTAL POSTPOLYPECTOMY AND EMR BLEEDING: A PROSPECTIVE COHORT STUDY. Endoscopy 2021; 53: S173.

Publication History

Article published online:
19 March 2021