Child-Pugh Score Is an Independent Risk Factor for Immediate Bleeding after Colonoscopic Polypectomy in Liver Cirrhosis

• Published in: Yonsei medical journal Vol. 55; no. 5; pp. 1281 - 1288
• Main Authors: Lee, Sangheun, Park, Soo Jung, Cheon, Jae Hee, Kim, Tae Il, Kim, Won Ho, Kang, Dae Ryong, Hong, Sung Pil
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.09.2014; 연세대학교의과대학
• Subjects: Aged; Colonoscopy - adverse effects; Female; Gastrointestinal Hemorrhage - epidemiology; Humans; Incidence; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Male; Middle Aged; Original; Postoperative Hemorrhage - epidemiology; Retrospective Studies; Risk Factors; Time Factors; 의학일반; polypectomy; colorectal polyps; colonoscopy; Bleeding; liver cirrhosis
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2014.55.5.1281

Post-polypectomy bleeding is the most common colonoscopic polypectomy complication. However, the risk of post-polypectomy bleeding in liver cirrhosis is unknown. We aimed to evaluate the risk of post-polypectomy bleeding in patients with liver cirrhosis. We included 89 patients with liver cirrhosis who received colonoscopic polypectomy between January 2006 and October 2012. Three hundred forty-eight subjects without liver disease who underwent colonoscopic polypectomy comprised the control group. Risks of post-polypectomy bleeding were analyzed according to patient- and polyp-related factors. Among 89 patients, 75 (84.3%) were Child-Pugh class A, 10 (11.2%) were class B, and 4 (4.5%) were class C. Incidence of immediate post-polypectomy bleeding was significantly increased in cirrhosis with Child-Pugh class B or C compared to liver cirrhosis with Child-Pugh class A or control group [hazard ratio (HR) 3.5; p<0.001]. Polyp size (HR 3.6; p=0.032) and pedunculated polyps (HR 2.4; p=0.022) were also significant risk factors for immediate post-polypectomy bleeding in multivariate analysis. Cirrhotic patients with Child-Pugh class B or C have a high risk of immediate post-polypectomy bleeding. Thus, endoscopists should be cautious about performing colonoscopic polypectomy in patients with Child-Pugh class B or C.