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Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy

Hosim Soh1, Jaeyoung Chun1,2, Seung Wook Hong1

  • 1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Gut and Liver
|December 10, 2019
PubMed

Insights

Patients with advanced chronic liver disease (CLD) and cirrhosis face higher risks of bleeding after colon polyp removal. This includes both immediate and delayed postpolypectomy bleeding (PPB).

Area of Science:

  • Gastroenterology
  • Hepatology
  • Endoscopic Procedures

Background:

  • The risk of postpolypectomy bleeding (PPB) in patients with chronic liver disease (CLD) is not well understood.
  • Liver cirrhosis, a severe form of CLD, may significantly influence bleeding risks during colonoscopy.

Purpose of the Study:

  • To determine the incidence and identify risk factors for colonoscopic PPB in patients with CLD.
  • To specifically assess the risk of PPB in patients with liver cirrhosis.

Main Methods:

  • Retrospective review of medical records of 1,267 CLD patients who underwent colonoscopic polypectomy.
  • Analysis of immediate and delayed PPB as study endpoints.
  • Comparison of bleeding rates across different stages of CLD, including Child-Pugh (CP) classifications.

Main Results:

  • Patients with CP-B or C cirrhosis showed significantly higher rates of both immediate (17.5%) and delayed (4.4%) PPB compared to CP-A or chronic hepatitis groups.
  • Independent risk factors for immediate PPB included CP-B/C cirrhosis, low platelet count (<50,000/μL), multiple polyps, advanced resection techniques, and trainee performance.
  • Independent risk factors for delayed PPB were CP-B/C cirrhosis and large polyp size (>10 mm).

Conclusions:

  • Patients with Child-Pugh B or C cirrhosis have a substantially increased risk of bleeding after colonoscopic polypectomy.
  • Identifying these risk factors is crucial for managing patients with CLD undergoing colonoscopic procedures.
Abstract

Keywords:
Chronic liver diseaseColonoscopyHepatitisLiver cirrhosisPostpolypectomy bleedingchronic

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