COLON POLYPECTOMY: PROSPECTIVE ANALYSIS OF RISK FACTORS FOR MAJOR COMPLICATIONS

Aims:

Endoscopic excision of lesions in the colon is generally safe and decisively contributes for avoiding colorectal cancer. Complications such bleeding or perforation are well established. We intend to study the complications after colon polypectomy at our unit and to understand the risk factors associated.

Methods:

Prospective cohort study with registration of all polypectomies between October 2013 and October 2018, in a single center. Evaluation of patients' characteristics (comorbidities, medication), lesions' characteristics (location, size, morphology, SMSA score), complications and outcomes. Statistical analysis included descriptive statistics, Qui² test and multivariable regression.

Results:

Performed 3732 polypectomies, in 1761 patients, median age 66 years (IQR 8). Use of antiaggregant in 8% (n = 299), direct-acting oral anticoagulants (DOAC) in 5% (n = 186), warfarin in 3% (n = 120). Lesions were mostly sessile/flat (70%, n = 2640), in the left colon (55%, n = 2069), median size 10 mm (IQR 5). Median SMSA score was 6, with 9.6% scoring SMSA≥3. Cold snare used in 30% and EMR in 9% of the lesions.

Complications occurred in 2,4% (n = 91), mostly bleeding (2%, n = 75) with mean time for delayed bleeding 6 days (± 0,5). Four perforations and 12 post-polypectomy electrocoagulation syndrome. Readmission needed in 2.6% (n = 46), generating 183 days in hospital, 12 blood units transfused, surgery in 2 of the 4 perforations. No all-cause mortality registered. Risk factors for complications in multivariable regression were SMSA≥3 (OR 7.6, IC95% 3 – 20) and use of DOAC (OR 5, IC95% 1.1 – 23) for delayed bleeding; EMR (OR 9, IC95% 3 – 28) and SMSA≥3 (OR 4, IC95% 1.2 – 14) for post-polypectomy electrocoagulation syndrome. No risk factors were found for perforation.

Conclusions:

Complications in our unit occurred within recommended thresholds, although complex polyps have higher risks for complications recommending the use of the SMSA score for risk stratification. Patients under DOAC need extra caution in their management and might deserve further study.