Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage: a multi-center case-control study

Am J Gastroenterol. 2011 Jun;106(6):1119-24. doi: 10.1038/ajg.2010.507. Epub 2011 Jan 25.


Objectives: Delayed hemorrhage is an infrequent, but serious complication of colonoscopic polypectomy. Large size is the only polyp-related factor that has been unequivocally proven to increase the risk of delayed bleeding. It has been suggested that location in the right hemi-colon is also a risk factor. The objective of this study was to determine whether polyp location is an independent risk factor for delayed post-polypectomy hemorrhage.

Methods: A retrospective case-control study was conducted in two university hospitals and two community hospitals.

Results: Thirty-nine cases and 117 controls were identified. In multivariate analysis, size and location were found to be independent polyp-related risk factors for delayed type hemorrhage. The risk increased by 13% for every 1 mm increase in polyp diameter (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.05-1.20, P<0.001). Polyps located in the right hemi-colon had an OR of 4.67 (1.88-11.61, P=0.001) for delayed hemorrhage. Polyps in the cecum seemed to be especially at high risk in univariate analysis (OR 13.82, 95% CI 2.66-71.73), but this could not be assessed in multivariate analysis as the number of cases was too small. Polyp type (sessile or pedunculated) was not a risk factor.

Conclusions: Polyp location in the right hemi-colon seems to be an independent and substantial risk factor for delayed post-polypectomy hemorrhage. A low threshold for preventive hemostatic measures is advised when removing polyps from this region.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Case-Control Studies
  • Colon, Ascending / pathology*
  • Colon, Ascending / surgery
  • Colonic Polyps / pathology
  • Colonic Polyps / surgery*
  • Colonoscopy / adverse effects*
  • Colonoscopy / methods
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Hospitals, University
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Postoperative Hemorrhage / diagnosis*
  • Postoperative Hemorrhage / epidemiology
  • Reference Values
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome