Early and delayed complications of polypectomy in a community setting: The SPoC prospective multicentre trial.
BACKGROUND
Colonoscopic polypectomy is effective in reducing the incidence of and mortality from colorectal cancer, but is not complication-free.


OBJECTIVE
To evaluate the incidence of early and delayed polypectomy complications and factors associated with their occurrence in a community setting.


METHODS
Web-database collection of patients' and polyp's features in consecutive colonic polypectomies during a 3-month period in 18 endoscopy centres.


RESULTS
Data on 5178 polypectomies in 2692 patients (54.3% males, mean age 59 years) were collected. The majority of the polyps were <10mm (83.5%). Antithrombotic agents were taken by 22.7% of patients, 57.3% of which withheld them before the procedure. Overall, 5 patients experienced perforations (0.2%) and 114 had bleeding (4.2%); the overall complication rate was 4.4%. Early complications were observed in 87 (3.2%); delayed complications (all major bleedings) occurred in 32 (1.2%). At multivariate analysis polyp size (size >10mm: OR 4.35, 95% CI 5.53-7.48) and, inversely, right-sided location (OR 0.58, 95% CI 0.36-0.94) were correlated with bleeding events. The use of antithrombotics was associated with 5-fold increased risk of delayed bleeding.


CONCLUSIONS
In the community setting, polypectomy was associated with a 1.4% risk of major complications. Polyp size and, inversely, right-sided location were associated with early bleeding; the use of antithrombotics increased the risk of delayed events.
Department of Gastroenterology, Valduce Hospital, Como, Italy. Electronic address: arnamato@gmail.com.
Arnaldo
A
Amato
Department of Gastroenterology, Valduce Hospital, Como, Italy.
Franco
F
Radaelli
Gastroenterology and Endoscopy Unit, San Gerardo Hospital, Monza, Italy.
Marco
M
Dinelli
Division of Endoscopy, European Institute of Oncology, Milano, Italy.
Cristiano
C
Crosta
Department of Surgery, University of Brescia, Spedali Civili, Brescia, Italy.
Gianpaolo
G
Cengia
Endoscopy Service, Città Studi Clinical Institute, Milano, Italy.
Paolo
P
Beretta
Department of Gastroenterology, AO Salvini, Rho Hospital, Italy.
Massimo
M
Devani
Endoscopy Unit, Policlinico di Monza, Monza, Italy.
Davide
D
Lochis
Department of Gastroenterology, AO Salvini, Garbagnate Hospital, Italy.
Giampiero
G
Manes
Department of Internal Medicine, AO Circolo, Busto Arsizio, Italy.
Lucia
L
Fini
Department of Gastroenterology, Valduce Hospital, Como, Italy.
Silvia
S
Paggi
Department of Gastroenterology, San Carlo Hospital, Milano, Italy.
Giovanni Rubis
GR
Passoni
Humanitas Research Hospital, Humanitas University, Milan, Italy.
Alessandro
A
Repici
D000368:Aged; D003106:Colon / Q000473:pathology*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011446:Prospective Studies; D013997:Time Factors
D005343:Fibrinolytic Agents
Colonoscopic polypectomy; Polypectomy complications