Bleeding Risk in Gastric Polypectomy
Incidence of Bleeding
- Gastric polypectomy is associated with a bleeding risk of 0.2% to 8% of procedures, similar to the bleeding risk seen with colonoscopic polypectomy, according to the American College of Cardiology 1
- The bleeding risk is comparable to colonoscopic polypectomy, which has a reported bleeding rate of 0.4% to 3.4% 2, 3
Types of Bleeding
- Immediate bleeding occurs during the procedure and can usually be controlled endoscopically, with a higher risk associated with cutting or blended electrical current 2, 3
- Delayed bleeding occurs up to 15-30 days after the procedure, resulting from sloughing of the eschar at the polypectomy site, and is usually self-limited, resolving with supportive care in more than 70% of cases 2, 3, 4, 5
Risk Factors for Bleeding
- Large polyp size (≥10 mm) significantly increases the risk of bleeding, with an adjusted OR of 4.5 (95% CI: 2.0-10.3) 2, 3
- Advanced age, male sex, and comorbid conditions, including hypertension, diabetes, coronary artery disease, and chronic obstructive pulmonary disease, also increase the risk of bleeding 2, 3
- The use of anticoagulants or antiplatelet medications increases the risk of bleeding 3
Prevention of Bleeding
- Technical considerations, such as the use of blended rather than pure cutting electrocautery currents, can reduce the risk of early bleeding 4, 5
- Cold snare or cold forceps removal of small polyps has a lower bleeding risk than hot biopsy techniques 1, 3
- Prophylactic placement of hemostatic clips can reduce bleeding risk, particularly for large polyps or those in high-risk locations 6
Management of Polypectomy Bleeding
- For immediate bleeding, injection of 1:10,000 epinephrine followed by multipolar cautery or clipping is an effective management strategy 3, 4, 5
- For delayed bleeding, loop ligation of the remaining polyp stalk, endoscopic band ligation, injection of adrenaline followed by thermal therapy, and application of endovascular clipping devices are effective management strategies 4, 5