PubMed · 7498673
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
J R Jass. 1995. Malignant colorectal polyps.. https://doi.org/10.1016/0016-5085(95)90775-0
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Endoscopic polypectomy is associated with a small but definite risk of bleeding and perforation. Patients with large adenomas are thus usually hospitalized for endoscopic resection. In order to evaluate whether these procedures can be performed in the setting of one day surgery, we retrospectively analyzed the complications and results of polypectomy done in the period from 1.1.1990 through 31.12.1994. Of 1399 colorectal adenomas respected in 680 patients, 385 (28%) were larger than 1 cm. Altogether we observed only 3 (0.2%) clinically significant complications: bleeding was seen in 2 patients, of whom only one required transfusion of one unit. One patient required surgery because of perforation after removal of a sessile cecal adenoma with uneventful outcome. These results show that endoscopic resection of colorectal adenomas is safe even if the polyps are large.
PURPOSE: This study was undertaken to evaluate the incidence, diagnostic methods, and treatment of hemorrhage occurring after colonoscopic polypectomy. METHODS: A retrospective chart review was conducted of 12,058 patients who underwent colonoscopy at an academic referral center between January 1989 and July 1993. Of these, 6,365 patients required polypectomies or biopsies. RESULTS: After these procedures, 13 patients (0.2 percent) developed lower gastrointestinal hemorrhage requiring hospitalization. All bleeding episodes occurred within 12 days of polypectomy or biopsy (mean = 8 days). Twelve patients (92 percent) underwent technetium-tagged red blood cell scintigraphy, which localized bleeding in four patients (31 percent). In the eight patients with normal scintigrams, hemorrhage did not recur, and no further evaluation was performed. Five patients (38 percent) underwent arteriography. Arteriogram was positive in two of four patients with positive scintigrams, and bleeding was controlled with selective vasopressin infusion. The fifth patient had arteriography without prior diagnostic studies because of massive hemorrhage; the bleeding site was identified and controlled with selective vasopressin infusion. Three patients had lower gastrointestinal endoscopy, with endoscopic identification of bleeding site in two patients, and endoscopic electrocautery controlled the bleeding in one patient. In the 13 patients with hemorrhage, cessation of bleeding occurred with intestinal rest and hydration in nine patients (69 percent), selective vasopressin infusion in three patients (23 percent), and endoscopic electrocautery in one patient (8 percent). Eight patients (62 percent) required blood transfusion with a mean of 4.8 units (excluding one patient on warfarin sodium who required 14 units of blood). No patient required surgical intervention. CONCLUSIONS: Incidence of hemorrhage after colonoscopic polypectomy or biopsy is low, and in our series, hemorrhage resolved without the need for surgical intervention. Management includes initial stabilization followed by diagnostic evaluation. Technetium-tagged red blood cell nuclear scintigraphy identifies ongoing bleeding and identifies patients in whom additional invasive procedures (arteriography lower gastrointestinal tract endoscopy) are warranted.