title: Incidence and risk factors of delayed postpolypectomy bleeding in patients with chronic liver disease.
abstract: Hepatologists and colonoscopists often hesitate to perform a colonoscopic polypectomy in patients with chronic liver disease (CLD), especially those with cirrhosis, because of the risk of postpolypectomy bleeding (PPB). We aimed to investigate the incidence and risk factors of delayed PPB after a colonoscopic polypectomy in patients with CLD.
  
  
  
  In total, 152 patients with CLD who underwent colonoscopic polypectomy from December 2005 to December 2012 were retrospectively reviewed.
  
  
  
  Cirrhosis was identified in 80 (52.6%) patients. During the study period, 442 polyps were removed and delayed PPB developed in 14 (9.2%) patients. The incidence of delayed PPB was significantly higher in patients with cirrhosis than in those without the disease (13.8% [n = 11] vs. 4.2% [n = 3], p = 0.041). The polyp size (odds ratio, 1.087; 95% confidence interval, 1.009-1.172) and cirrhosis (odds ratio, 8.535; 95% confidence interval, 2.417-30.140) were independent risk factors for delayed PPB. In patients with cirrhosis, the optimal cut-off size to identify high-risk polyps for delayed PPB was 10 mm (area under the receiver operating characteristics curve, 0.737; sensitivity, 52%; specificity, 88%).
  
  
  
  Caution is needed when colonoscopic polypectomy is planned in patients with CLD who have larger polyps and cirrhosis.
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;
authors.forename: Hee Seung
authors.initials: HS
authors.lastname: Lee
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;|b Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea ;
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Park
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;|b Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea ;|c Liver Cirrhosis Clinical Research Center , Seoul , Korea.
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;
authors.forename: Jeung Eun
authors.initials: JE
authors.lastname: Lee
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;
authors.forename: Ga Lam
authors.initials: GL
authors.lastname: Leem
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;
authors.forename: Yonsoo
authors.initials: Y
authors.lastname: Kim
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;|b Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea ;|c Liver Cirrhosis Clinical Research Center , Seoul , Korea.
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;|b Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea ;|c Liver Cirrhosis Clinical Research Center , Seoul , Korea.
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;|b Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea ;|c Liver Cirrhosis Clinical Research Center , Seoul , Korea.
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;|b Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea ;|c Liver Cirrhosis Clinical Research Center , Seoul , Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea ;|b Institute of Gastroenterology, Yonsei University College of Medicine , Seoul , Korea ;|c Liver Cirrhosis Clinical Research Center , Seoul , Korea.
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
mesh_terms: D002908:Chronic Disease; D003082:Colectomy / Q000009:adverse effects*; D003111:Colonic Polyps / Q000150:complications / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors
keywords: Chronic liver disease; colonoscopy; liver cirrhosis; postpolypectomy bleeding