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Risk factors for post-polypectomy bleeding in patients with end-stage renal disease undergoing colonoscopic polypectomy

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Abstract

Background and aims

Little is known about the risk factors of bleeding after colonoscopic polypectomy in patients with end-stage renal disease (ESRD). This study investigated the incidence and risk factors of post-polypectomy bleeding (PPB), including immediate and delayed bleeding, in patients with ESRD.

Methods

Ninety-two patients with ESRD who underwent colonoscopic polypectomy between September 2005 and June 2020 at a single tertiary referral center were included. The patients’ medical records were retrospectively reviewed. Patient- and polyp-related factors associated with immediate PPB (IPPB) were analyzed using logistic regression analysis. Additionally, the optimal cutoff polyp size related to a significant increase in the risk of IPPB was determined by performing receiver operating characteristic (ROC) analysis and calculating the area under the ROC curve (AUC).

Results

In total, 286 polyps were removed. IPPB occurred in 24 (26.1%) patients and 46 (16.1%) polyps and delayed PPB occurred in 2 (2.2%) patients. According to multivariate analysis, the polyp size (> 7 mm), old age (> 70), and endoscopic mucosal resection (EMR) as the polypectomy method (EMR versus non-EMR) were found to be independent risk factors for IPPB. According to the Youden index method, the optimal cutoff polyp size to identify high-risk polyps for IPPB was 7 mm (AUC = 0.755; sensitivity, 76.1%; specificity, 69.6%).

Conclusions

Colonoscopic polypectomy should be performed with caution in patients with ESRD, especially in those with the following risk factors: advanced age (> 70 years), polyp size > 7 mm, and EMR as the polypectomy method.

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Abbreviations

ESRD:

End-stage renal disease

PPB:

Post-polypectomy bleeding

IPPB:

Immediate post-polypectomy bleeding

DPPB:

Delayed post-polypectomy bleeding

EMR:

Endoscopic mucosal resection

CSP:

Cold snare polypectomy

HSP:

Hot snare polypectomy

RRT:

Renal replacement therapy

HD:

Hemodialysis

PD:

Peritoneal dialysis

OR:

Odds ration

CI:

Confidence interval

ROC:

Receiver operating characteristic

AUC:

Area under the receiver operating characteristic curve

INR:

International normalized ratio

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Acknowledgements

We thank the patients who participated in this study, their caregivers, and the study investigators and members of the KASID.

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Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Jung Hyun Ji, Hyun Woo Kim, Jihye Park, Soo Jung Park, Jae Hee Cheon, Tae Il Kim & Jae Jun Park

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  1. Jung Hyun Ji
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Correspondence to Jae Jun Park.

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Jung Hyun Ji, Hyun Woo Kim, Jihye Park, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, and Jae Jun Park have no potential conflict of interest was reported by any of the authors.

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Ji, J.H., Kim, H.W., Park, J. et al. Risk factors for post-polypectomy bleeding in patients with end-stage renal disease undergoing colonoscopic polypectomy. Surg Endosc 38, 846–856 (2024). https://doi.org/10.1007/s00464-023-10626-5

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