Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage: a multi-center case-control study.
OBJECTIVE
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.
Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands. k.t.buddingh@chir.umcg.nl
K Tim
KT
Buddingh
Thomas
T
Herngreen
Jelle
J
Haringsma
Wil C
WC
van der Zwet
Frank P
FP
Vleggaar
Ronald
R
Breumelhof
Frank
F
Ter Borg
D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D044682:Colon, Ascending / Q000473:pathology* / Q000601:surgery; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome