Hemoclipping for postpolypectomy and postbiopsy colonic bleeding☆,☆☆,★

Presented in part at the World Congress of Gastroenterology, Vienna, Austria, September 1998.
https://doi.org/10.1016/S0016-5107(00)70384-1Get rights and content

Abstract

Background: Obtaining colonoscopic biopsies and polypectomy can result in hemorrhage. The most effective management of this complication has not been determined. The objective of this study was to evaluate the endoscopic hemoclip in postprocedural colonic bleeding. Methods: Among 9555 consecutive colonoscopies, cases of postprocedural colonic bleeding (postpolypectomy and postbiopsy) requiring treatment were retrospectively reviewed. Endoscopic hemoclipping was initially attempted in each case; the rate of hemostasis after hemoclipping, use of additional hemostatic methods, and clinical outcome (need for transfusion/hospitalization) were analyzed. Results: There were 72 cases of bleeding in which treatment was required (45 immediate postpolypectomy, 18 delayed postpolypectomy and 9 postbiopsy). Endoscopic hemostasis was achieved in all cases of immediate postpolypectomy and postbiopsy bleeding and in all but one of the cases with delayed postpolypectomy bleeding. A detachable snare was used in addition to hemoclips in 3 cases of delayed postpolypectomy bleeding. There were no episodes of recurrent bleeding, deaths or need for surgery related to bleeding. Conclusion: Early endoscopic management of postprocedural bleeding by hemoclipping provides hemostasis in the great majority of cases. (Gastrointest Endosc 2000;51:37-41.)

Section snippets

Methods

From January 1995 to April 1998, 9555 colonoscopic examinations were performed at our hospital. Cases in which polypectomy was performed or biopsies obtained were reviewed for postprocedural bleeding, and all cases in which endoscopic hemostasis was attempted were included in the study. When bleeding took place before discharge from the procedure room, it was considered immediate postpolypectomy bleeding (IPB); bleeding after discharge was considered delayed postpolypectomy bleeding (DPB).

In

Results

There were 72 cases of postprocedural bleeding that required treatment. The sources of bleeding were polypectomy sites in 63 cases (IPB in 45 and DPB in 18) and biopsy sites in 9.

Discussion

When arterial IPB occurs, a concerted effort should be made to stop the bleeding.12 IPB has been managed with a variety of modalities (Table 1). Rosen et al.13 managed 7 of 9 cases by observation alone and 2 of 9 by resnaring of the stalk. Macrae et al.3 used endoscopic therapy (stalk constriction with snare, coagulation, adrenaline) in 23 of 29 cases of minor bleeding and observation in the rest; for major hemorrhage endoscopic control was successful in 10 of 13 cases and the remaining 3

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    ☆

    Adolfo Parra-Blanco is supported by European Union Science & Technology Fellowship Programme in Japan (EUS&TFPJ) (ERB IC17 CT960062).

    ☆☆

    Reprint requests: Rikiya Fujita, MD, Division of Gastroenterology, Fujigaoka Hospital, Showa University, 1-30 Fujigaoka, Aoba-ku, 227 Yokohama, Japan.

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    Copyright © 2000 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.