1. Post-polypectomy Bleeding SANTHAT NIVATVONGS MD COLON AND RECTAL SURGERY MAYO CLINIC ROCHESTER MINNESOTA U.S.A.

5. Post-Polypectomy Bleeding Mayo Clinic Experience Colonoscopic Polypectomy ( snare / hot biopsy ) 1989 – 1996 Number of polyps 14,575 Number of patients with bleeding 83 ( 274 polyps ) Sorbi G et al. Gastrointest Endos 2000; 51:690

6. Post-Polypectomy Bleeding Mayo Clinic Experience Profile of Patients with Post-polypectomy Bleeding No. of patients 83 Median age 73 (28-88) M : F 56: 27 Median time from polypectomy 5 d. ( 0-17) Medications: Aspirin 33% Heparin 23% Warfarin 12% NSAIDs 11% Sorbi D et al. Gastrointest Endosc. 2000;51:690

7. Post-polypectomy Bleeding Severity of Bleeding Intensive care unit 42 patients Medical floor 41 Requiring blood transfusion 50 ( % )

8. Post-Polypectomy Bleeding Diagnosis Identify by colonoscopy 65 patients No stigmata of bleeding 18 Total 83 Most common site of bleeding = cecum 21 / 65 ( 32 % )

10. Postpolypectomy Bleeding Immediate bleeding Delay bleeding Secondary bleeding

11. Post-Polypectomy Bleeding Outcome No. % All patients 83 100 Colonoscopic treatment 80 96 Not requiring therapy 4 5 Recurrent bleeding 8 10 Requiring surgery 4 5 Embolization 1 1 Death related to polypectomy 0 0

12. Post-Polypectomy Bleeding Colonoscopic Treatment Epinephrine injection and coagulation 51 % Coagulation / heater probe 49 %

16. Preventing Postpolypectomy Bleeding Full control of the scope Know your limitation Stop anticoagulant --- warfarin, plavix Submucosal saline injection Use only coagulation current