title: Child-Pugh score is an independent risk factor for immediate bleeding after colonoscopic polypectomy in liver cirrhosis.
abstract: OBJECTIVE
  Post-polypectomy bleeding is the most common colonoscopic polypectomy complication. However, the risk of post-polypectomy bleeding in liver cirrhosis is unknown. We aimed to evaluate the risk of post-polypectomy bleeding in patients with liver cirrhosis.
  
  
  METHODS
  We included 89 patients with liver cirrhosis who received colonoscopic polypectomy between January 2006 and October 2012. Three hundred forty-eight subjects without liver disease who underwent colonoscopic polypectomy comprised the control group. Risks of post-polypectomy bleeding were analyzed according to patient- and polyp-related factors.
  
  
  RESULTS
  Among 89 patients, 75 (84.3%) were Child-Pugh class A, 10 (11.2%) were class B, and 4 (4.5%) were class C. Incidence of immediate post-polypectomy bleeding was significantly increased in cirrhosis with Child-Pugh class B or C compared to liver cirrhosis with Child-Pugh class A or control group [hazard ratio (HR) 3.5; p<0.001]. Polyp size (HR 3.6; p=0.032) and pedunculated polyps (HR 2.4; p=0.022) were also significant risk factors for immediate post-polypectomy bleeding in multivariate analysis.
  
  
  CONCLUSIONS
  Cirrhotic patients with Child-Pugh class B or C have a high risk of immediate post-polypectomy bleeding. Thus, endoscopists should be cautious about performing colonoscopic polypectomy in patients with Child-Pugh class B or C.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sangheun
authors.initials: S
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Tae Il
authors.initials: TI
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.affiliation: Biostatistics Collaboration Unit, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dae Ryong
authors.initials: DR
authors.lastname: Kang
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. SPHONG@yuhs.ac.
authors.forename: Sung Pil
authors.initials: SP
authors.lastname: Hong
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Bleeding; colonoscopy; colorectal polyps; liver cirrhosis; polypectomy