MANAGEMENTUL ŞI PROFILAXIA HEMORAGIEI POSTPOLIPECTOMIE.

Postpolypectomy bleeding is the most common complication of endoscopic polypectomy, being life threatening in massive hemorrhage. It can be divided in early bleeding which occurs immediately after polypectomy and delayed bleeding which appears after hours to up to 30 days after polypectomy. The aim of this study was to identify the risk factors and the prophylactic management for developing early/delayed postpolypectomy hemorrhage. Methods. This was a retrospective study of patients who developed early or delayed hematochezia after endoscopic polypectomy, between January 2013 - March 2014 in the Clinical Emergency Hospital Bucharest. These cases were retrospectively reviewed regarding risk factors, pathological findings and prophylactic methods or treatment of bleeding. Results. We introduced in the study 71 patients with polypectomies. We had 17 cases (23,94%) with early bleeding, 12 (16,90%) cases with delayed hemorrhage and 42 cases (59,15%) in which we have used prophylactic methods. The risk factors for early bleeding were the size of polyp (median size 2,8 cm), the morphology (thick stalk, sessile). All the bleedings, even the arterial spurting ones were effectively controlled by endoscopic management. Methods included hemoclip placement in all cases and adrenalin injection or electrocoagulation. The patients with delayed bleeding presented in average on the 6th day. The main risk factors were the type of the polyp (sessile), the size (average 10 mm), the old age (more than 60 years), the use of aspirin (even if the guidelines do not contraindicate polypectomy during treatment with aspirin) and early reinitiation of antithrombotic agents. 2 of 12 patients from this group presented with massive bleeding requiring transfusions with packed red blood cells units and urgent colonoscopies. All the cases were successful managed by placing hemoclips and/or injection or thermal probes. We studied a separate group of 42 patients with pedunculated polyps >2 cm / sessile or with aspirin and clopidogrel therapy, in which we had to use prophylactic measures consisting of adrenalin submucosal injection, endoloop placed prior to polypectomy and hemoclips placed prior or after the polypectomy. Only one case of immediate bleeding occurred after endoloop detachment, but it was successfully managed by hemoclips placement. No delayed bleeding occurred after prophylactic measures. Conclusions. Most of postpolypectomy bleedings can be efficiently managed by endoscopic treatment, depending on the endoscopist's technique and availability of hemoclips. In the presence of risk factors (pedunculated polyps >2 cm, sessile polyps, aspirin/clopidogrel use, age >60 years), we recommend prophylactic measures with hemoclips. We recommend the patient to refrain from aspirin for at least 7 days prior to polypectomy if the polyp is larger than 1 cm and the indication is primary prophylaxis, despite the recommendation from the ASGE. [ABSTRACT FROM AUTHOR]