A Clinical Tool to Predict Delay Post-Polypectomy Bleeding After Resection of Colorectal Polyps

Abstract

Background: Delay post-polypectomy bleeding (DPB) is the most frequent complication after colonoscopic polypectomy. However, only few studies have investigated the prediction of bleeding. We aimed to derive a nomogram to predict the risk of DPB.

Methods: Data on patient, polyp and polypectomy procedure were analysed. The cohort was randomly divided to the training and test group. Independent factors of DPB in the training cohort were identified by multiple logistic regression analysis and used to develop a risk score. The risk score was validated in the independent test cohort.

Results: A total of 1738 patients with 3650 polyps were included in the study. The rate of DPB in this study was 1.9% (71/3650). In the training group, the independent predictors were age (HR 0.384), prophylactic clipping (HR 0.384), polyp morphology (HR 2.546), polyp size (HR 2.491), thrombin time (HR 4.263). The derived risk score comprised age<60 years, prophylactic clipping, polyp morphology of Ip/Isp, polyp size≥10mm, TT≥21 sec. In the validation cohort, the C-index for DPB prediction was 0.802. Subgroup analysis showed that prophylactic clipping is not suitable for small (<10mm) polyps.

Conclusions: We derive a readily applicable risk score that identifies patients with high risk of DPB. This score may help improving the management of those undergoing polypectomy and assist in allocating resources more cost-effectively to prevent and manage DPB. In addition, we found prophylactic clipping may increase the risk of DPB. Further well-designed researches are needed to demonstrate it.