Post-polypectomy Bleeding

SANTHAT NIVATVONGS MD

COLON AND RECTAL SURGERY

MAYO CLINIC

ROCHESTER MINNESOTA

U.S.A.

Post-Polypectomy BleedingMayo Clinic Experience

Colonoscopic Polypectomy ( snare / hot biopsy )

1989 – 1996

Number of polyps 14,575

Number of patients with bleeding 83 ( 274 polyps )

Sorbi G et al. Gastrointest Endos 2000; 51:690

Post-Polypectomy BleedingMayo Clinic Experience

Profile of Patients with Post-polypectomy Bleeding

No. of patients 83 Median age 73 (28-88)

M : F 56: 27 Median time from polypectomy 5 d. ( 0-17)

Medications: Aspirin 33%

Heparin 23%

Warfarin 12%

NSAIDs 11% Sorbi D et al. Gastrointest Endosc. 2000;51:690

Post-polypectomy BleedingSeverity of Bleeding

Intensive care unit 42 patients

Medical floor 41

Requiring blood transfusion 50 ( % )

Post-Polypectomy BleedingDiagnosis

Identify by colonoscopy 65 patients

No stigmata of bleeding 18

Total 83

Most common site of bleeding = cecum 21 / 65 ( 32 % )

Postpolypectomy Bleeding

Immediate bleeding

Delay bleeding

Secondary bleeding

Post-Polypectomy BleedingOutcome

No. %

All patients 83 100

Colonoscopic treatment 80 96

Not requiring therapy 4 5

Recurrent bleeding 8 10

Requiring surgery 4 5

Embolization 1 1

Death related to polypectomy 0 0

Post-Polypectomy BleedingColonoscopic Treatment

Epinephrine injection and coagulation 51 %

Coagulation / heater probe 49 %

Preventing Postpolypectomy Bleeding

Full control of the scope

Know your limitation Stop anticoagulant --- warfarin, plavix

Submucosal saline injection

Use only coagulation current