Post-polypectomy bleeding in the English National Health Service Bowel Cancer Screening Programme

Background and study aims Colonoscopic polypectomy reduces colorectal cancer incidence, but is associated with complications including post-polypectomy bleeding (PPB). PPB ranges in severity from minor to life-threatening, making interpretation and comparison difficult. No previous studies have examined PPB rate according to a standardized severity grading system. We aimed to determine the PPB rate stratified by severity grading, explore factors that contribute to PPB severity grading, and describe PPB management. Methods Data relating to PPB were prospectively collected from all colonoscopies performed in one region of the English NHS Bowel Cancer Screening Programme (BCSP) from 06/12/2010 to 15/07/2014. PPB was defined and stratified into major, intermediate, and minor according to BCSP standardized definitions based on the American Society for Gastrointestinal Endoscopy adverse events lexicon. Results A total of 15 285 colonoscopies (23 766 polypectomies) were analyzed. The PPB rate per colonoscopy was 0.44% (95% confidence interval [CI] 0.34 - 0.54) and the rate per polypectomy was 0.29% (95% CI 0.20 - 0.38); 2.9% of PPBs were major and 42.6% were intermediate. Repeat endoscopy occurred in 27.9% and was the most common reason for bleeding being categorized as of intermediate severity, although therapy was applied in only 36.8% of these cases. A therapeutic intervention was significantly more common in patients with PPB who had either a hemoglobin drop >= 2 g/dL and/or a blood transfusion (P = 0.04, relative risk 3.47, 95% CI 1.05 - 11.52). Conclusions This study specifically examined colonoscopic PPB rate, stratified using standardized criteria. The rates of PPB were low, with the majority of PPB being of minor severity. Current stratification of PPB severity combines measures of bleed severity with interventions. Using only hemoglobin drop = 2 g/dL and/or blood transfusion as markers of PPB severity may simplify stratification, and allow a better assessment of the necessity and impact of an intervention.