Post-polypectomy colorectal bleeding: current strategies and the way forward
Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophyla...
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| Language: | English |
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Korean Society of Gastrointestinal Endoscopy
2025-03-01
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| Series: | Clinical Endoscopy |
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| Online Access: | http://e-ce.org/upload/pdf/ce-2024-241.pdf |
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| author | Nilanga Nishad Mo Hameed Thoufeeq |
| author_facet | Nilanga Nishad Mo Hameed Thoufeeq |
| author_sort | Nilanga Nishad |
| collection | DOAJ |
| description | Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding. |
| format | Article |
| id | doaj-art-23c0d4ca5a3d433aa7e3ba7f1e60198a |
| institution | OA Journals |
| issn | 2234-2400 2234-2443 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Korean Society of Gastrointestinal Endoscopy |
| record_format | Article |
| series | Clinical Endoscopy |
| spelling | doaj-art-23c0d4ca5a3d433aa7e3ba7f1e60198a2025-08-20T01:51:39ZengKorean Society of Gastrointestinal EndoscopyClinical Endoscopy2234-24002234-24432025-03-0158219120010.5946/ce.2024.2417956Post-polypectomy colorectal bleeding: current strategies and the way forwardNilanga Nishad0Mo Hameed Thoufeeq1 Department of Gastroenterology, Sheffield University Hospitals NHS Trust, Sheffield, United Kingdom Department of Gastroenterology, Sheffield University Hospitals NHS Trust, Sheffield, United KingdomPost-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding.http://e-ce.org/upload/pdf/ce-2024-241.pdfclippingcolonoscopypost-polypectomy bleedingpurastat |
| spellingShingle | Nilanga Nishad Mo Hameed Thoufeeq Post-polypectomy colorectal bleeding: current strategies and the way forward Clinical Endoscopy clipping colonoscopy post-polypectomy bleeding purastat |
| title | Post-polypectomy colorectal bleeding: current strategies and the way forward |
| title_full | Post-polypectomy colorectal bleeding: current strategies and the way forward |
| title_fullStr | Post-polypectomy colorectal bleeding: current strategies and the way forward |
| title_full_unstemmed | Post-polypectomy colorectal bleeding: current strategies and the way forward |
| title_short | Post-polypectomy colorectal bleeding: current strategies and the way forward |
| title_sort | post polypectomy colorectal bleeding current strategies and the way forward |
| topic | clipping colonoscopy post-polypectomy bleeding purastat |
| url | http://e-ce.org/upload/pdf/ce-2024-241.pdf |
| work_keys_str_mv | AT nilanganishad postpolypectomycolorectalbleedingcurrentstrategiesandthewayforward AT mohameedthoufeeq postpolypectomycolorectalbleedingcurrentstrategiesandthewayforward |