Risk factors for delayed post-polypectomy bleeding: Systematic review and meta-analysis
Kamal F, Khan MA, Reddy YK, Haq KF, Heda RP, Tariq R, Ismail MK, Tombazzi C, and Howden CW. Risk factors for delayed post-polypectomy bleeding: Systematic review and meta-analysis. Gastrointestinal Endoscopy 2020; 91(6):AB508-AB509.
Background: Delayed post-polypectomy bleeding (DPPB) is an important complication of colonoscopic polypectomy that can be associated with substantial morbidity and may require hospitalization, blood transfusion, repeat colonoscopy and, rarely, angiographic embolization or surgery. Studies have evaluated and reported different risk factors for DPPB. Aim: To identify risk factors for DPPB by systematic review and meta-analysis of observational studies Methods: We conducted a systematic search of databases including Pubmed, Scopus, Web of science and Cochrane library from inception to November 2019 for studies reporting risk factors for DPPB. Adjusted odds ratios (OR) with 95% confidence intervals (CI) for individual risk factors were pooled using random effects model. I2statistics were used to assess heterogeneity. Publication bias was assessed by Egger’s test. Results: We included 21 observational studies with 48,990 patients. Results are summarized in Table 1. Factors that were associated with increased risk of DPPB included polyp size >10mm (OR 3.05; Figure 1A), right-sided colon polyps (OR 2.56; Figure 1B), immediate post-polypectomy bleeding (OR 2.86), hypertension (OR 1.68), use of anticoagulants/antiplatelet agents (OR 4.33), and heparin bridging (OR 10.61). Macroscopic form of polyps (pedunculated vs. sessile) was not associated with increased risk of DPPB; pooled OR (95% CI) = 1.36 (0.88, 2.11); I2= 57%. Heparin bridging was associated with the highest risk of DPPB (pooled OR (95% CI) = 10.61 (6.46, 17.43); I2= 17%). There were low levels of heterogeneity for all these risk factors except macroscopic form of polyps (I2= 57%). We found no evidence of publication bias. Conclusions: Polyp size >10mm, right colon polyp location, immediate post-polypectomy bleeding, hypertension, use of anticoagulants/antiplatelet agents and heparin bridging are associated with increased risks of DPPB. Heparin bridging is associated with a very high risk of DPPB; benefits of bridging should be carefully weighed against its risks in these patients.