Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

Abstract

Oliver Bendall,1 Joel James,1 Katarzyna M Pawlak,2 Sauid Ishaq,3,4 J Andy Tau,5 Noriko Suzuki,6 Steven Bollipo,7,8 Keith Siau1 1Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, UK; 2Endoscopy Unit, Department of Gastroenterology, Ministry of Interior and Administration, Szczecin, Poland; 3Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK; 4Medicine, Birmingham City Hospital, Birmingham, UK; 5Austin Gastroenterology, Austin, TX, USA; 6Wolfson Unit for Endoscopy, St. Mark’s Hospital, London, UK; 7School of Medicine & Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; 8Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, New South Wales, AustraliaCorrespondence: Keith SiauDepartment of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, TR1 3LJ, UKEmail [email protected]: Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3– 1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summary of factors that contribute to the risk of DPPB before discussing pragmatic interventions to mitigate their risk and improve patient safety.Keywords: colonoscopy, polypectomy, haemorrhage, adverse event, complications

Keywords

• colonoscopy
• polypectomy
• haemorrhage
• adverse event
• complications