Background and study aims: Cirrhotic patients are at a theoretically increased risk of bleeding. The safety
of polypectomy in cirrhosis is poorly defined.
Patients and methods: We performed a retrospective review of patients with cirrhosis who underwent colonoscopic
polypectomy at a tertiary-care hospital. Patient characteristics and polyp data were
collected. Development of complications including immediate bleeding, delayed bleeding,
hospitalization, blood transfusion, perforation, and death were recorded to 30-day
follow-up. Clinical characteristics between bleeders and non-bleeders were compared,
and predictors of bleeding were determined.
Results: A total of 307 colonoscopies with 638 polypectomies were identified. Immediate bleeding
occurred in 7.5 % (95 % CI 4.6 % – 10.4 %) and delayed bleeding occurred in 0.3 %
(95 % CI 0.0 % – 0.9 %) of colonoscopies. All cases of immediate bleeding were controlled
endoscopically and none resulted in serious complication. The rate of hospitalization
was 0.7 % (95 % CI 0.0 % – 1.6 %) and repeat colonoscopy 0.3 % (95 % CI 0.0 % – 0.9 %);
no cases of perforation, blood transfusion, or death occurred. Lower platelet count,
higher INR, presence of ascites, and presence of esophageal varices were associated
with increased risk of bleeding. Use of electrocautery was associated with a lower
risk of immediate bleeding. There was no significant difference between bleeding and
non-bleeding polyps with regard to size, morphology, and histology.
Conclusions: Colonoscopy with polypectomy appears safe in patients with cirrhosis. There is a
low risk of major complications. The risk of immediate bleeding appears higher than
an average risk population; however, most bleeding is self-limited or can be controlled
endoscopically. Bleeding tends to occur with more advanced liver disease. Both the
sequelae of portal hypertension and coagulation abnormalities are predictive of bleeding.
