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- Post-polypectomy colorectal bleeding: current strategies and the way forward
- Nilanga Nishad, Mo Hameed Thoufeeq
- Clin Endosc 2025;58(2):191-200. Published online November 27, 2024
- DOI: https://doi.org/10.5946/ce.2024.241
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Abstract
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ePub - Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding.
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Citations
Citations to this article as recorded by
- Prophylactic clipping versus no clipping after endoscopic mucosal resection of large non-pedunculated colon polyps: a cost-effectiveness analysis
Sneh Sonaiya, Raj Patel, Charmy Parikh, Magnus Chun, Amrit Narwan, Karan Yagnik, Pranav Patel, Bradley Confer, Harshit Khara, Babu P. Mohan
Gastrointestinal Endoscopy.2025;[Epub] CrossRef - Over-the-Scope Clip vs Standard Endoscopic Therapy as First-Line Intervention for Nonvariceal Upper Gastrointestinal Bleeding: A Cost-Effectiveness Analysis
Sneh Sonaiya, Sahib Singh, Tooba Laeeq, Vaishnavi Modi, Magnus Chun, Pranav Patel, Vignan Manne, Babu P. Mohan
Techniques and Innovations in Gastrointestinal Endoscopy.2025; 27(4): 250935. CrossRef - Cold snare polypectomy versus hot snare polypectomy for small pedunculated polyps: a cost-effectiveness analysis
Sneh Sonaiya, Raj Patel, Dushyant Singh Dahiya, Shahryar Khan, Charmy Parikh, Mark Stasiewicz, Pranav D. Patel, Kyaw Min Tun, Bradley Confer, Harshit S. Khara, Sumant Inamdar, Vignan Manne, Babu P. Mohan, Douglas G. Adler
Gastrointestinal Endoscopy.2025;[Epub] CrossRef - Cold Versus Hot Endoscopic Mucosal Resection for ≥15 mm Large Nonpedunculated Colorectal Polyps
Sneh Sonaiya, Dushyant S. Dahiya, Raj Patel, Shahryar Khan, Charmy Parikh, Karan Yagnik, Chun-Han Lo, Kyaw Min Tun, Pranav D. Patel, Bradley Confer, Harshit S. Khara, Sumant Inamdar, Babu P. Mohan
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef
- Prophylactic clipping versus no clipping after endoscopic mucosal resection of large non-pedunculated colon polyps: a cost-effectiveness analysis
- 12,957 View
- 664 Download
- 2 Web of Science
- 4 Crossref
- Endoscopic Management of Post-Polypectomy Bleeding
- Aditya Gutta, Mark A. Gromski
- Clin Endosc 2020;53(3):302-310. Published online September 17, 2019
- DOI: https://doi.org/10.5946/ce.2019.062
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Abstract
PDFPubReaderePub
- Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.
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Citations
Citations to this article as recorded by- Bleeding Risk During Colorectal Endoscopic Mucosal Resection With Continued Anticoagulant Therapy: A Multicenter Study
Sayo Kobayashi, Keita Harada, Toru Nawa, Tomoo Fujisawa, Toru Ueki, Junichiro Nasu, Yuki Morito, Tatsuya Toyokawa, Tomoki Inaba, Masahide Kita, Ryuta Takenaka, Masafumi Inoue, Reiji Higashi, Takao Tsuduki, Minoru Matsubara, Yasushi Yamasaki, Hiroyuki Okad
Cureus.2025;[Epub] CrossRef - Clinical Trial: Precise Administration of Sucralfate Powder in Prevention of Delayed Postpolypectomy Bleeding. A Randomized Controlled Trial
Hsueh-Chien Chiang, Po-Jun Chen, Er-Hsiang Yang, Tzu-Ling Kuo, Ming-Tsung Hsieh, Jui-Wen Kang, Hsiu-Chi Cheng, Wei-Lun Chang, Wei-Ying Chen, Hung-Chih Chiu, Meng-Ying Lin, Tzu-Chun Hong, Chien-Ming Chiang, Wei-Chih Chen, Kuan-Kai Huang, Meng-Hsuan Lu, Min
Clinical and Translational Gastroenterology.2025; 16(4): e00818. CrossRef - Chronic Kidney Disease Increases Risk of Delayed Post‐Polypectomy Bleeding: A Large‐Scale Propensity Score‐Matched Analysis
Hye Kyung Hyun, Nak‐Hoon Son, So Hyeon Gwon, Hyun Chul Lim, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim, Tae‐Hyun Yoo, Shin‐Wook Kang, Hae‐Ryong Yun, Cheal Wung Huh
United European Gastroenterology Journal.2025; 13(5): 759. CrossRef - Safety and Efficacy of Cold Compared With Hot Endoscopic Mucosal Resection of Large Nonpedunculated Colorectal Polyps: Systematic Review and Meta-Analysis
Bashar Qumseya, William King, Michael Ladna, Ahmed Sarheed, Bishal Paudel, Robyn E. Rosasco
American Journal of Gastroenterology.2025; 120(12): 2889. CrossRef - Minimum Platelet Count Threshold for Safe Colonoscopic Polypectomy: A Large-Scale Propensity Scored-Matched Analysis
Hye Kyung Hyun, Nak-Hoon Son, Cheal Wung Huh, Hyun Chul Lim, So Hyeon Gwon, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim
American Journal of Gastroenterology.2025; 120(12): 2918. CrossRef - Role of clips, devices and sprays in endoscopic hemostasis: An update (with videos)
Nikhil Sonthalia, Rajesh Puri, Shivam Sethi
Indian Journal of Gastroenterology.2025; 44(5): 595. CrossRef - Advances in standardized diagnosis and management of pediatric gastrointestinal bleeding
Qian-Cheng Xu, Zi-Yu Liu, Fei Gao, Ya-Te He, Xiao-Rui He, Wei Zheng, Mi-Zu Jiang
World Journal of Pediatrics.2025; 21(12): 1218. CrossRef - Delayed post-polypectomy perforation: A case report of a 65-year-old man at 54 days post-procedure
Donghyoun Lee, Beom Jun Lee, Jung Woo Yi, Robert Kim, Yuchul Jeong
Medicine.2025; 104(46): e45311. CrossRef - Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon
Hisham Wehbe, Aditya Gutta, Mark A. Gromski
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 363. CrossRef - Colonoscopic polypectomy of juvenile polyps in children: Experience from a tertiary centre of Bangladesh
Salahuddin Mahmud, Mashud Parvez, Madhabi Baidya, Farhana Tasneem, Ahmed Rashidul Hasan, Tanzila Farhana, Md Jahangir Alam, Syed Shafi Ahmed
Gastroenterology & Endoscopy.2024; 2(1): 1. CrossRef - Review article: Advances in the management of lower gastrointestinal bleeding
Ali A. Alali, Majid A. Almadi, Alan N. Barkun
Alimentary Pharmacology & Therapeutics.2024; 59(5): 632. CrossRef - Endoscopic management of intraprocedural bleeding during endoscopic interventions
Ali A. Alali, Asma A. Alkandari
Best Practice & Research Clinical Gastroenterology.2024; 69: 101912. CrossRef - Effect of Cold Versus Hot Snare Polypectomy on Colon Postpolypectomy Bleeding in Patients with End-Stage Renal Disease: A Retrospective Cohort Study
Hsueh-Chien Chiang, Chien-Ming Chiang, Xi-Zhang Lin, Po-Jun Chen
Digestive Diseases and Sciences.2024; 69(7): 2381. CrossRef - Sigmoid perforation after endoscopic clip placement in an infant: A case report
Lucia Fein, Gabriela Carro, Bernardo Berazategui
Journal of Pediatric Surgery Case Reports.2024; 110: 102892. CrossRef - Outpatient endoscopic polypectomy
S. N. Skridlevskiy, A. A. Likutov, L. V. Nazarov, E. A. Bogdanova, I. S. Bogormistrov
Koloproktologia.2024; 23(4): 17. CrossRef - Prediction of immediate bleeding after cold snare polypectomy: A prospective observational study
Shin Ju Oh, Yunho Jung, Young Hwangbo, Young Sin Cho, Il Kwun Chung, Chang Kyun Lee
Medicine.2024; 103(36): e39597. CrossRef - Colonic polypectomy in 2024: hot or cold?
K Ferdinande, L Desomer, D De Looze, D.J. Tate
Acta Gastro Enterologica Belgica.2024; 87(4): 505. CrossRef - Isolated ischaemic appendicitis as a rare complication of selective angioembolization for lower gastrointestinal bleed
Luke S. Crawford, Nadim S. Jafri, Dingle Foote, Melissa M. Felinski, Peter A. Walker, Kulvinder S. Bajwa, Shinil K. Shah
ANZ Journal of Surgery.2023; 93(1-2): 404. CrossRef - JAG consensus statements for training and certification in colonoscopy
Keith Siau, Stavroula Pelitari, Susi Green, Brian McKaig, Arun Rajendran, Mark Feeney, Mo Thoufeeq, John Anderson, Vathsan Ravindran, Paul Hagan, Neil Cripps, Ian L P Beales, Karen Church, Nicholas I Church, Elizabeth Ratcliffe, Said Din, Rupert D Pullan,
Frontline Gastroenterology.2023; 14(3): 201. CrossRef - JAG consensus statements for training and certification in flexible sigmoidoscopy
Keith Siau, Stavroula Pelitari, Susi Green, Brian McKaig, Arun Rajendran, Mark Feeney, Mo Thoufeeq, John Anderson, Vathsan Ravindran, Paul Hagan, Neil Cripps, Ian L P Beales, Karen Church, Nicholas I Church, Elizabeth Ratcliffe, Said Din, Rupert D Pullan,
Frontline Gastroenterology.2023; 14(3): 181. CrossRef - Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline
Neil Sengupta, Joseph D. Feuerstein, Vipul Jairath, Amandeep K. Shergill, Lisa L. Strate, Robert J. Wong, David Wan
American Journal of Gastroenterology.2023; 118(2): 208. CrossRef - Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition
Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
Intestinal Research.2023; 21(1): 20. CrossRef - A Review of Colonoscopy in Intestinal Diseases
Seung Hong, Dong Baek
Diagnostics.2023; 13(7): 1262. CrossRef - Bleeding After Endoscopic Resection of Colonic Adenomatous Polyps Sized 4-10 mm
Violeta Hristova Janik
PRILOZI.2023; 44(2): 157. CrossRef - Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps: two or more clips may be safe
Xue-Feng Guo, Xiang-An Yu, Jian-Cong Hu, De-Zheng Lin, Jia-Xin Deng, Ming-Li Su, Juan Li, Wei Liu, Jia-Wei Zhang, Qing-Hua Zhong
Gastroenterology Report.2022;[Epub] CrossRef - Clinical progress note: Diagnostic approach to lower gastrointestinal bleeding
Daniel J. Stein, Hyder Said, Joseph D. Feuerstein
Journal of Hospital Medicine.2022; 17(7): 547. CrossRef - Safety of Cold Snare Polypectomy for Small Colorectal Polyps in Patients Receiving Antithrombotic Therapy
Dai Nakamatsu, Tsutomu Nishida, Yoshifumi Fujii, Sho Yamaoka, Naoto Osugi, Aya Sugimoto, Kaori Mukai, Kengo Matsumoto, Masashi Yamamoto, Shiro Hayashi, Sachiko Nakajima
Techniques and Innovations in Gastrointestinal Endoscopy.2022; 24(3): 246. CrossRef - Postcolonoscopy Complications
Jetsen A. Rodriguez-Silva, Justin A. Maykel
Diseases of the Colon & Rectum.2022; 65(5): 622. CrossRef - Expanding rather than closing the wound can rescue the endoscopic procedure when massive bleeding occurs during endoscopic submucosal dissection
Ming-Ching Yuan, Ching-Tai Lee, Kun-Feng Tsai, Chao-Wen Hsu, Chu-Kuang Chou
Endoscopy.2022; 54(S 02): E1036. CrossRef - Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revised Edition
Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
The Korean Journal of Gastroenterology.2022; 80(3): 115. CrossRef - Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition
Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
Clinical Endoscopy.2022; 55(6): 703. CrossRef - Can prophylactic argon plasma coagulation reduce delayed post‐papillectomy bleeding? A prospective multicenter trial
Jae Kook Yang, Jong Jin Hyun, Tae Hoon Lee, Jun‐Ho Choi, Yun Nah Lee, Jung Wan Choe, Jin‐Seok Park, Chang‐Il Kwon, Seok Jeong, Hong Ja Kim, Jong Ho Moon, Sang‐Heum Park
Journal of Gastroenterology and Hepatology.2021; 36(2): 467. CrossRef - Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Konstantinos Triantafyllou, Paraskevas Gkolfakis, Ian M. Gralnek, Kathryn Oakland, Gianpiero Manes, Franco Radaelli, Halim Awadie, Marine Camus Duboc, Dimitrios Christodoulou, Evgeny Fedorov, Richard J. Guy, Marcus Hollenbach, Mostafa Ibrahim, Ziv Neeman,
Endoscopy.2021; 53(08): 850. CrossRef - Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in vitro experiment
Dong Dong Sun, Dan Lv, Wei Zhou Wu, He Fei Ren, Bu He Bao, Qun Liu, Ming Lin Sun
Journal of Orthopaedic Surgery and Research.2020;[Epub] CrossRef
- Bleeding Risk During Colorectal Endoscopic Mucosal Resection With Continued Anticoagulant Therapy: A Multicenter Study
- 20,717 View
- 683 Download
- 31 Web of Science
- 34 Crossref
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