Abstract
Background and study aims Colonoscopic polypectomy reduces colorectal cancer incidence, but is associated with
complications including post-polypectomy bleeding (PPB). PPB ranges in severity from
minor to life-threatening, making interpretation and comparison difficult. No previous
studies have examined PPB rate according to a standardized severity grading system.
We aimed to determine the PPB rate stratified by severity grading, explore factors
that contribute to PPB severity grading, and describe PPB management.
Methods Data relating to PPB were prospectively collected from all colonoscopies performed
in one region of the English NHS Bowel Cancer Screening Programme (BCSP) from 06/12/2010
to 15/07/2014. PPB was defined and stratified into major, intermediate, and minor
according to BCSP standardized definitions based on the American Society for Gastrointestinal
Endoscopy adverse events lexicon.
Results A total of 15 285 colonoscopies (23 766 polypectomies) were analyzed. The PPB rate
per colonoscopy was 0.44 % (95 % confidence interval [CI] 0.34 – 0.54) and the rate
per polypectomy was 0.29 % (95 %CI 0.20 – 0.38); 2.9 % of PPBs were major and 42.6 %
were intermediate. Repeat endoscopy occurred in 27.9 % and was the most common reason
for bleeding being categorized as of intermediate severity, although therapy was applied
in only 36.8 % of these cases. A therapeutic intervention was significantly more common
in patients with PPB who had either a hemoglobin drop ≥ 2 g/dL and/or a blood transfusion
(P = 0.04, relative risk 3.47, 95 %CI 1.05 – 11.52).
Conclusions This study specifically examined colonoscopic PPB rate, stratified using standardized
criteria. The rates of PPB were low, with the majority of PPB being of minor severity.
Current stratification of PPB severity combines measures of bleed severity with interventions.
Using only hemoglobin drop ≥ 2 g/dL and/or blood transfusion as markers of PPB severity
may simplify stratification, and allow a better assessment of the necessity and impact
of an intervention.
