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DOI: 10.1055/s-0042-111317
Colonoscopy with polypectomy is associated with a low rate of complications in patients with cirrhosis
Publication History
submitted 04 December 2015
accepted after revision 23 June 2016
Publication Date:
08 August 2016 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201609/lookinside/thumbnails/465_10-1055-s-0042-111317-1.jpg)
Background and study aims: Cirrhotic patients are at a theoretically increased risk of bleeding. The safety of polypectomy in cirrhosis is poorly defined.
Patients and methods: We performed a retrospective review of patients with cirrhosis who underwent colonoscopic polypectomy at a tertiary-care hospital. Patient characteristics and polyp data were collected. Development of complications including immediate bleeding, delayed bleeding, hospitalization, blood transfusion, perforation, and death were recorded to 30-day follow-up. Clinical characteristics between bleeders and non-bleeders were compared, and predictors of bleeding were determined.
Results: A total of 307 colonoscopies with 638 polypectomies were identified. Immediate bleeding occurred in 7.5 % (95 % CI 4.6 % – 10.4 %) and delayed bleeding occurred in 0.3 % (95 % CI 0.0 % – 0.9 %) of colonoscopies. All cases of immediate bleeding were controlled endoscopically and none resulted in serious complication. The rate of hospitalization was 0.7 % (95 % CI 0.0 % – 1.6 %) and repeat colonoscopy 0.3 % (95 % CI 0.0 % – 0.9 %); no cases of perforation, blood transfusion, or death occurred. Lower platelet count, higher INR, presence of ascites, and presence of esophageal varices were associated with increased risk of bleeding. Use of electrocautery was associated with a lower risk of immediate bleeding. There was no significant difference between bleeding and non-bleeding polyps with regard to size, morphology, and histology.
Conclusions: Colonoscopy with polypectomy appears safe in patients with cirrhosis. There is a low risk of major complications. The risk of immediate bleeding appears higher than an average risk population; however, most bleeding is self-limited or can be controlled endoscopically. Bleeding tends to occur with more advanced liver disease. Both the sequelae of portal hypertension and coagulation abnormalities are predictive of bleeding.
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References
- 1 D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44: 217-231
- 2 Scaglione S, Kliethermes S, Cao G et al. The Epidemiology of Cirrhosis in the United States: A Population-based Study. J Clin Gastroenterol 2014; 49: 690-691
- 3 Lieberman DA, Rex DK, Winawer SJ et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
- 4 Rex DK, Johnson DA, Anderson JC et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol 2009; 104: 739-750
- 5 Jeon JW, Shin HP, Lee JI et al. The risk of postpolypectomy bleeding during colonoscopy in patients with early liver cirrhosis. Surg Endosc 2012; 26: 3258-3263
- 6 Lee S, Park SJ, Cheon JH et al. Child-Pugh score is an independent risk factor for immediate bleeding after colonoscopic polypectomy in liver cirrhosis. Yonsei Med J 2014; 55: 1281-1288
- 7 Tripodi A, Mannucci PM. The coagulopathy of chronic liver disease. N Engl J Med 2011; 365: 147-156
- 8 Ito K, Shiraki K, Sakai T et al. Portal hypertensive colopathy in patients with liver cirrhosis. World J Gastroenterol 2005; 11: 3127-3130
- 9 Runyon BA. Management of Adult Patients with Ascites Due to Cirrhosis: Update 2012. In: American Association for the Study of Liver Diseases. Alexandria (VA): 2013
- 10 Kim HS, Kim TI, Kim WH et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am J Gastroenterol 2006; 101: 1333-1341
- 11 Rabeneck L, Paszat LF, Hilsden RJ et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008; 135: 1899-1906, 1906 e1891
- 12 Chukmaitov A, Bradley CJ, Dahman B et al. Association of polypectomy techniques, endoscopist volume, and facility type with colonoscopy complications. Gastrointest Endosc 2013; 77: 436-446
- 13 Lieberman DA, Weiss DG, Bond JH et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med 2000; 343: 162-168
- 14 Van Gossum A, Cozzoli A, Adler M et al. Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of current. Gastrointest Endosc 1992; 38: 472-475
- 15 Zhang Q, An S, Chen Z et al. Assessment of risk factors for delayed colonic post-polypectomy hemorrhage: a study of 15553 polypectomies from 2005 to 2013. PLoS One 2014; 9: e108290
- 16 Waye JD, Lewis BS, Yessayan S. Colonoscopy: a prospective report of complications. J Clin Gastroenterol 1992; 15: 347-351
- 17 Committee ASoP. Khashab MA, Chithadi KV et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2015; 81: 81-89
- 18 Christ AD, Bauerfeind P, Gyr N. Peritonitis after colonoscopy in a patient with ascites. Endoscopy 1993; 25: 553-554
- 19 Shrake PD, Troiano F, Rex DK. Peritonitis following colonoscopy in a cirrhotic with ascites. Am J Gastroenterol 1989; 84: 453-454