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

Abstract

Background and aim 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.

Patients and methods 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.

Results 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.

Conclusions 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.

Zusammenfassung

Hintergrund und Ziele Blutungen nach Polypektomie (PPB) bleiben eine seltene, wenn auch schwerwiegende Komplikation der Koloskopie. Ziel dieser Studie ist es, die PPB-Prävalenz in einem Sekundärkrankenhaus und die damit verbundenen Risikofaktoren zu bestimmen.

Patienten und Methoden Wir sammelten Data von 581 Patienten, wobei zwischen August 2017 und August 2019 1.593 Polypen entfernt wurden. Eine univariate binäre logistische Regressionsanalyse wurde retrospektiv durchgeführt.

Ergebnisse PPB trat nur in 10 Fällen auf, welches 1,7 % der Patienten entspricht: sofort in 1,2 % und verzögert in 0,5 %. Die Anzahl der entfernten Polypen pro Patient (4,5 [SD 2,59] für hämorrhagische vs. 2,74 [SD 1,98] für nicht hämorrhagische Gruppe) und die Propofol-Dosis (232 mg [SD 93,07] für hämorrhagische vs. 133 mg [SD 57,28] für nicht hämorrhagische Gruppe) waren relevante patientenbezogene Risikofaktoren. Die polypenbasierte Analyse zeigte die Polypengröße (18,4 mm [SD 10,44] für die hämorrhagische vs. 4,42 mm [SD 4,29] für die nicht hämorrhagische Gruppe), die Morphologie (breitbasig: OR 24,83 [95 % CI 2,76 – 223,44], gestielt: OR 56,67 [95 % CI 5,03 – 638,29]), die Position an der Ileozökalklappe [OR 20,48, 95 % CI 1,81 – 231,97]) und die Polypektomiemethode (Elektroschlinge piecemeal mit Adrenalininjektion: OR 75,38 [95 % CI 7,67 – 741,21]) als signifikante Risikofaktoren auch für PPB.

Schlussfolgerungen Die niedrige PPB-Rate bestätigt die Sicherheit dieses Verfahrens in nicht tertiären Koloskopiezentren mit hohem Volumen. Die Anzahl der pro Patient entfernten Polypen, die Polypengröße, Morphologie und Lokalisation sowie die Sedierungsdosis und die Methode der Polypektomie wurden als relevante Risikofaktoren angegeben.

Schlüsselwörter

Adenom - Polypektomie - Blutung - Risikofaktor - submukosale Unterspritzung - Adrenalin - Schlinge - Piecemeal-Resektion - Blutstillung - Clip

Keywords

adenoma - polypectomy - bleeding - risk factor - submucosal injection - epinephrine - snare - piecemeal resection - hemostasis - clip

Publikationsverlauf

Eingereicht: 22. Januar 2021

Angenommen nach Revision: 01. November 2021

Artikel online veröffentlicht:
14. Dezember 2021

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