International Journal of Colorectal Disease

, Volume 32, Issue 10, pp 1399–1406 | Cite as

Risk factors for delayed colonic post-polypectomy bleeding: a systematic review and meta-analysis

  • Veeravich Jaruvongvanich
  • Narut Prasitlumkum
  • Buravej Assavapongpaiboon
  • Sakolwan Suchartlikitwong
  • Anawin Sanguankeo
  • Sikarin UpalaEmail author
Original Article



Delayed post-polypectomy bleeding (PPB) is an infrequent but serious adverse event after colonoscopic polypectomy. Several studies have tried to identify risk factors for delayed PPB, with inconsistent results. This meta-analysis aims to identify significant risk factors for delayed PPB.


MEDLINE and EMBASE databases were searched through January 2016 for studies that investigated the risk factors for delayed PPB. Pooled odds ratio (OR) for categorical variables and mean differences (MD) for continuous variables and 95% confidence interval (CI) were calculated using a random-effect model, generic inverse variance method. The between-study heterogeneity of effect size was quantified using the Q statistic and I 2.


Twelve articles involving 14,313 patients were included. The pooled delayed PPB rate was 1.5% (95%CI, 0.7–3.4%), I 2 = 96%. Cardiovascular disease (OR = 1.55), hypertension (OR = 1.53), polyp size > 10 mm (OR = 3.41), and polyps located in the right colon (OR = 1.60) were identified as significant risk factors for delayed PPB, whereas age, sex, alcohol use, smoking, diabetes, cerebrovascular disease, pedunculated morphology, and carcinoma histology were not.


Cardiovascular disease, hypertension, polyp size, and polyp location were associated with delayed PPB. More caution is needed when removing polyps in patients with these risk factors. Future studies are warranted to determine appropriate preventive hemostatic measures in these patients.


Bleeding Colonoscopy Meta-analysis Polypectomy Risk factors 



We thank Matthew Roslund to validate the search.

Author contributions

VJ conceived of the study, assessed the quality of the studies, and drafted the manuscript. SU searched the literature, assessed the quality of the studies, performed the statistical analysis, and drafted the manuscript. AS, BA, NP, and SS participated in the statistical analysis and drafted the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Competing interests

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent.

Disclosure statement

The authors have nothing to disclose.

Supplementary material

384_2017_2870_MOESM1_ESM.jpg (289 kb)
Supplementary figure 1 Search methodology and selection process (JPEG 288 kb)
384_2017_2870_MOESM2_ESM.pdf (2.1 mb)
Supplementary figure 2 (PDF 2133 kb)
384_2017_2870_MOESM3_ESM.pdf (1.2 mb)
Supplementary figure 3 (PDF 1223 kb)
384_2017_2870_MOESM4_ESM.docx (14 kb)
Item S1 Search strategy (DOCX 14.1 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Veeravich Jaruvongvanich
    • 1
    • 2
  • Narut Prasitlumkum
    • 2
  • Buravej Assavapongpaiboon
    • 2
  • Sakolwan Suchartlikitwong
    • 2
    • 3
  • Anawin Sanguankeo
    • 4
    • 5
  • Sikarin Upala
    • 4
    • 5
    Email author
  1. 1.Department of Internal MedicineUniversity of HawaiiHonoluluUSA
  2. 2.Department of MedicineKing Chulalongkorn Memorial HospitalBangkokThailand
  3. 3.Department of Internal MedicineTexas Tech Medical CenterLubbockUSA
  4. 4.Department of Internal MedicineBassett Medical Center and Columbia University College of Physicians and SurgeonsCooperstownUSA
  5. 5.Department of Preventive and Social Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand

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