title: Colonoscopy with polypectomy is associated with a low rate of complications in patients with cirrhosis.
abstract: OBJECTIVE
  Cirrhotic patients are at a theoretically increased risk of bleeding. The safety of polypectomy in cirrhosis is poorly defined.
  
  
  METHODS
  We performed a retrospective review of patients with cirrhosis who underwent colonoscopic polypectomy at a tertiary-care hospital. Patient characteristics and polyp data were collected. Development of complications including immediate bleeding, delayed bleeding, hospitalization, blood transfusion, perforation, and death were recorded to 30-day follow-up. Clinical characteristics between bleeders and non-bleeders were compared, and predictors of bleeding were determined.
  
  
  RESULTS
  A total of 307 colonoscopies with 638 polypectomies were identified. Immediate bleeding occurred in 7.5 % (95 % CI 4.6 % - 10.4 %) and delayed bleeding occurred in 0.3 % (95 % CI 0.0 % - 0.9 %) of colonoscopies. All cases of immediate bleeding were controlled endoscopically and none resulted in serious complication. The rate of hospitalization was 0.7 % (95 % CI 0.0 % - 1.6 %) and repeat colonoscopy 0.3 % (95 % CI 0.0 % - 0.9 %); no cases of perforation, blood transfusion, or death occurred. Lower platelet count, higher INR, presence of ascites, and presence of esophageal varices were associated with increased risk of bleeding. Use of electrocautery was associated with a lower risk of immediate bleeding. There was no significant difference between bleeding and non-bleeding polyps with regard to size, morphology, and histology.
  
  
  CONCLUSIONS
  Colonoscopy with polypectomy appears safe in patients with cirrhosis. There is a low risk of major complications. The risk of immediate bleeding appears higher than an average risk population; however, most bleeding is self-limited or can be controlled endoscopically. Bleeding tends to occur with more advanced liver disease. Both the sequelae of portal hypertension and coagulation abnormalities are predictive of bleeding.
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Huang
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, CA.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Perumpail
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Nirav
authors.initials: N
authors.lastname: Thosani
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA; Gastroenterology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Cheung
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA; Gastroenterology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Shai
authors.initials: S
authors.lastname: Friedland