TY - JOUR
AU1 - MD, Matthew Woo,
AU2 - MD, Robert Bechara,
AB - Colonoscopy, Endoscopy, Hemostasis A 68-year-old male with multiple medical comorbidities, including end-stage renal peritoneal dialysis, underwent screening colonoscopy prior to kidney transplant. Colonoscopy demonstrated three polyps in the descending colon; a 2-mm sessile polyp was removed with cold snare; a 7-mm sessile was polyp removed with hot snare; and distal to that, a 1-cm sessile polyp was removed with hot snare. There were no immediate complications, and the patient was discharged home. He represented a week later with 24 hours of rectal bleeding and a hemoglobin drop from 101 g/L to 76 g/L. Repeat colonoscopy showed a large adherent clot that measured the width of the lumen (Figure 1). Two clips were placed at the base (Figure 2), and this was removed with hot-snare (Figure 3), demonstrating a 2–3 mm vessel that was clipped (Figure 4, 5). He was discharged with no recurrence of bleeding. Figure 1. View largeDownload slide Large adherent clot at site of previous polypectomy (top-left). Figure 1. View largeDownload slide Large adherent clot at site of previous polypectomy (top-left). Figure 2. View largeDownload slide Clot clipped at the base (top-right). Figure 2. View largeDownload slide Clot clipped at the base (top-right). Figure 3. View largeDownload slide Clot removed with hot-snare (bottom-left). Figure 3. View largeDownload slide Clot removed with hot-snare (bottom-left). Figure 4. View largeDownload slide Visible vessel at site of previous polypectomy (clip to scale). Figure 4. View largeDownload slide Visible vessel at site of previous polypectomy (clip to scale). Figure 5. View largeDownload slide Visible vessel at site of previous polypectomy (small). Figure 5. View largeDownload slide Visible vessel at site of previous polypectomy (small). Discussion Postpolypectomy bleeding (PPB) is a known complication of colonoscopic polypectomy and is reported to occur at a frequency of 0.3%–10.2% (1). Some factors associated with PPB include polyp size, location in the right colon, sessile morphology, number of polyps removed and use of antiplatelet and anticoagulant use (2). PPB can be classified as immediate, when bleeding occurs immediately after polyp resection, or delayed, when bleeding occurs after the colonoscopy. A propensity-matched retrospective cohort study in 539 patients with colorectal polyps up to 11 mm in size demonstrated significantly less delayed postpolypectomy bleeding with cold snare polypectomy than hot snare polypectomy (3). Endoscopic hemostasis with clips is safe and effective in PPB. (4) There is varying evidence regarding the role for prophylactic endoscopic therapy. A systematic review and network meta-analysis of 15 RCTs involving 3462 patients who underwent colonoscopic polypectomy (median polyp size 16 mm) demonstrated relative efficacy of epinephrine-saline injection (RR=0.32, 0.11–0.67) and mechanical therapies (RR=0.13, 0.03–0.37) for reducing early PPB (<24 hours postpolypectomy), but not delayed PPB (5). Conflicts of interest The authors have no conflicts of interest to declare. References 1. Gimeno-García AZ, de Ganzo ZA, Sosa AJ, et al.   Incidence and predictors of postpolypectomy bleeding in colorectal polyps larger than 10 mm. Eur J Gastroenterol Hepatol . 2012; 24( 5): 520. Google Scholar CrossRef Search ADS PubMed  2. Pigò F, Bertani H, Manno M, et al.   Colonic postpolypectomy bleeding is related to polyp size and heparin use. Clin Endosc . 2017; 50 (3): 287– 292. doi: 10.5946/ce.2016.126. Google Scholar CrossRef Search ADS PubMed  3. Yamashina T, Fukuhara M, Maruo T, et al.   Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: A propensity score-matching analysis. Endosc Int Open . 2017; 5( 7): E587– E594. Google Scholar CrossRef Search ADS PubMed  4. Lee J-M, Kim WS, Kwak MS, et al.   Clinical outcome of endoscopic management in delayed postpolypectomy bleeding. Intest Res . 2016; 15( 2): 221– 227. Google Scholar CrossRef Search ADS   5. Park CH, Jung YS, Nam E, et al.   Comparison of efficacy of prophylactic endoscopic therapies for postpolypectomy bleeding in the colorectum: A systematic review and network meta-analysis. Am J Gastroenterol . 2016; 111( 9): 1230– 1243. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
TI - Post-polypectomy Visible Vessel
JF - Journal of the Canadian Association of Gastroenterology
DO - 10.1093/jcag/gwy015
DA - 2018-06-01
UR - https://www.deepdyve.com/lp/oxford-university-press/post-polypectomy-visible-vessel-roU0DzHw8u
SP - 1
EP - 52
VL - Advance Article
IS - 2
DP - DeepDyve
ER -