Management of complications of colonoscopic polypectomy

Complications can occur following therapeutic endoscopy. The most serious complication is bleeding, which occurs in 1.4% of all colonoscopic polypectomies. Perforation occurs in 0.3% of patients and postpolypectomy coagulation syndrome is seen in 1% of all patients following polypectomy. Bleeding is a dramatic complication, but most cases can be handled colonoscopically without the need for surgery or angiography. For patients who present with delayed bleeding (2% of all patients), emergency colonoscopy should be performed if the patient has active ongoing bleeding. Once a patient stops bleeding, rebleeding is not commonly seen. A schema is given for polypectomy when the patient is on anticoagulants. Other postpolypectomy syndromes discussed include pain, a contrecoup burn of the wall, and the transmural burn. Most of these resolve without any therapy. A review of the literature and personal comments are included in this article, which provides practical guidelines for postpolypectomy complications.