Incidence and risk factors of delayed postpolypectomy bleeding: a retrospective cohort study

J Clin Gastroenterol. 2014 Oct;48(9):784-9. doi: 10.1097/MCG.0000000000000027.


Background/aim: Delayed bleeding is a serious complication that occurs after polypectomy. Many risk factors for delayed bleeding have been suggested, but there is little analysis of procedure-related risk factors. The purpose of this study is to identify a wide range of risk factors for delayed postpolypectomy bleeding (DPPB) and analyze the correlations of those potential DPPB risk factors.

Materials and methods: In this retrospective cohort study, 5981 polypectomies in 3788 patients were evaluated between January 2010 and February 2012. Patient-related, polyp-related, and procedure-related factors were evaluated as potential DPPB risk factors.

Results: Delayed bleeding occurred in 42 patients (1.1%). Multivariate analysis revealed that polyp size >10 mm [odds ratio (OR), 2.785; 95% confidence interval (CI), 1.406-5.513; P=0.003], location in the right hemi-colon (OR, 2.289; 95% CI, 1.117-4.693; P=0.024), and endoscopist's experience (<300 total cases of colonoscopy performed; OR, 4.803; 95% CI, 2.631-8.766; P=0.001) were significant risk factors for DPPB. Especially protruded type polyps (Ip, Isp) larger than 1 cm in the right-side colon were associated with increased risk. Right-side polypectomy by a nonexpert endoscopist was a significant risk factor for DPPB, especially with procedures in the cecum area. Taking the 1.5% DPPB incidence as cutoff value, the learning curve of colonoscopic polypectomy may be estimated as 400 cases of polypectomy.

Conclusions: Polyp size, endoscopist's experience, and right hemi-colon location were identified as potential risk factors for DPPB development.

MeSH terms

  • Cohort Studies
  • Colonic Diseases / epidemiology*
  • Colonic Diseases / etiology
  • Colonic Neoplasms / pathology
  • Colonic Neoplasms / prevention & control
  • Colonic Polyps / surgery*
  • Colonoscopy / adverse effects
  • Female
  • Gastrointestinal Hemorrhage / epidemiology*
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Hemorrhage / epidemiology*
  • Postoperative Hemorrhage / etiology
  • Republic of Korea / epidemiology
  • Retrospective Studies
  • Risk Factors