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

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 r...

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Bibliographic Details
Published in:Clinical and experimental gastroenterology 2021-01, Vol.14, p.477-492
Main Authors: Bendall, Oliver, James, Joel, Pawlak, Katarzyna M, Ishaq, Sauid, Tau, J Andy, Suzuki, Noriko, Bollipo, Steven, Siau, Keith
Format: Article
Language:English
Subjects:
adverse event
Aggregation
Anticoagulants
Apixaban
Aspirin
Blood groups
Blood platelets
Blood vessels
Cerebrovascular disease
Colonoscopy
Colorectal cancer
complications
Endoscopy
Gastroenterology
haemorrhage
Health aspects
Hypertension
Intervention
Liver diseases
Medical research
Medical screening
Meta-analysis
Pathogenesis
Patient safety
polypectomy
Polyps
Review
Risk factors
Rivaroxaban
Surgery
Thrombolytic drugs
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Summary: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.
ISSN:1178-7023
1178-7023
DOI:10.2147/CEG.S282699