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Child-Pugh score is an independent risk factor for immediate bleeding after colonoscopic polypectomy in liver

Sangheun Lee1, Soo Jung Park1, Jae Hee Cheon1

  • 1Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Yonsei Medical Journal
|July 23, 2014
PubMed

Insights

Patients with advanced liver cirrhosis (Child-Pugh class B or C) face a significantly higher risk of immediate bleeding after colon polyp removal. Endoscopists must exercise caution during colonoscopic polypectomy in these high-risk individuals.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Endoscopic Surgery

Background:

  • Post-polypectomy bleeding is a common complication of colonoscopic polypectomy.
  • The bleeding risk in patients with liver cirrhosis remains largely uncharacterized.

Purpose of the Study:

  • To evaluate the risk of post-polypectomy bleeding in patients diagnosed with liver cirrhosis.
  • To identify patient- and polyp-related factors associated with bleeding after colon polypectomy in cirrhotic patients.

Main Methods:

  • A retrospective analysis of 89 patients with liver cirrhosis undergoing colonoscopic polypectomy.
  • Comparison with a control group of 348 subjects without liver disease who underwent similar procedures.
  • Multivariate analysis to determine risk factors for immediate post-polypectomy bleeding.

Main Results:

  • Patients with Child-Pugh class B or C liver cirrhosis showed a significantly increased incidence of immediate post-polypectomy bleeding compared to Child-Pugh class A or controls (HR 3.5; p<0.001).
  • Significant risk factors for bleeding included larger polyp size (HR 3.6; p=0.032) and the presence of pedunculated polyps (HR 2.4; p=0.022).

Conclusions:

  • Liver cirrhosis, particularly Child-Pugh class B or C, is associated with a high risk of immediate post-polypectomy bleeding.
  • Endoscopists should exercise increased caution when performing colonoscopic polypectomy in cirrhotic patients with advanced liver disease (Child-Pugh class B or C).
Abstract

Keywords:
Bleedingcolonoscopycolorectal polypsliver cirrhosispolypectomy

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