Aims Post polypectomy haemorrhage (PPH) can occur in 6-10% of cases of colonic polyps
> 20mm. Risk factors suggested include lesion size, proximal location and use of anticoagulants
or antiplatelets. Topical haemostats and clips could be used for prevention. Our study
compares their use for resections > 20mm.
Methods This was a retrospective, observational study over 22 months. Records were analysed
to identify polyp resections >20 mm. Data regarding size, location, details of prophylactic
therapy and use of concurrent anticoagulant/antiplatelet use were collected. Admissions
for delayed bleeding were measured over a 30-day period.
Results 226 patients underwent colonoscopy with 266 polyp resections > 20mm. Anticoagulation
was present in 30 patients (13.3%) and antiplatelet drugs in 58 patients (25.7%).
EndoClot was applied in 25 resections with delayed bleeding in 1 patient (4%). Mechanical
clips were used in 78 lesions with 8 incidents of delayed bleeding in this cohort
(10.3%). We did not use any prophylactic therapy in 111 patients with no PPH. There
were 13 patients with polyps > 50mm. 12 received prophylactic therapy with only 1
incidence of delayed bleeding. Detailed results are shown below.
Tab. 1
Detailed Results
|
Endoclot (n=25)
|
Clips (n=78)
|
Other eg: coagulation/Purastat (n=52)
|
None (n=111)
|
|
Location (proximal, distal, rectal)
|
88% (22); 4% (1); 8% (2)
|
64.1% (50); 24.4% (19); 11.5% (9)
|
59.6% (31); 28.8% (15); 11.5% (6)
|
82.9% (92); 14.4% (16); 2.7% (3)
|
|
Anticoagulants
|
DOAC 16% (4)
|
DOAC 14.1% (11); Warfarin 1.3% (1)
|
DOAC 1.9% (1); Warfarin 1.9% (1); Clexane 3.8% (2)
|
DOAC 7.2% (8); Warfarin 1.8% (2)
|
|
Antiplatelets
|
Aspirin 24% (6); Clopidogrel 0%
|
Aspirin 14.1% (11); Clopidogrel 6.4% (5)
|
Aspirin 25% (13); Clopidogrel 1.9% (1); DAPT 1.9% (1)
|
Aspirin 17.1% (19); Clopidogrel 1.8% (2)
|
|
PPH
|
4% (1)
|
10.3% (8)
|
7.7% (4)
|
0%
|
Conclusions In our high-risk cohort, prophylactic use of EndoClot and clips suggests lower PPH
with the topical haemostat. A larger number had clips used in the distal colon and
were on anticoagulation. Our study was limited by its retrospective design and choice
of prophylaxis based on clinician preference. Prospective data is required to identify
an ideal subset of patients where topical therapy would be beneficial.
