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Published on: May 10, 2021
Endoscopic Management of Post-Polypectomy Bleeding
Aditya Gutta1, Mark A Gromski1
1Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Post-polypectomy bleeding (PPB) is a common endoscopic polypectomy complication. Prompt endoscopic management is key for immediate PPB, while severe delayed bleeding requires stabilization before endoscopic therapy.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
Background:
- Post-polypectomy bleeding (PPB) is a frequent complication following endoscopic polypectomy.
- Risk factors encompass patient and polyp characteristics, influencing bleeding occurrence.
Purpose of the Study:
- To review the management strategies for immediate and delayed post-polypectomy bleeding.
- To identify future research directions for optimizing PPB prevention and treatment.
Main Methods:
- Review of current literature and clinical practices regarding PPB.
- Discussion of risk factors, immediate endoscopic management, and delayed bleeding presentations.
- Exploration of emerging endoscopic techniques and therapeutic agents.
Main Results:
- Immediate PPB is often manageable with prompt endoscopic intervention.
- Delayed PPB necessitates hemodynamic stabilization followed by endoscopic evaluation and therapy.
- Severe cases require prioritized resuscitation before endoscopic procedures.
Conclusions:
- Timely recognition and endoscopic management are crucial for immediate PPB.
- Hemodynamic stabilization is paramount in severe delayed PPB cases.
- Further research is needed on anticoagulants, polypectomy techniques, and novel hemostatic agents.
Abstract:
Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.
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