intestinal polypectomy

^[1]^[2]^[3]^[4]^[5]

Indications

postpolypectomy electrocoagulation syndrome
hemorrhage
- post-polypectomy bleeding more common in patients on anticoagulation even with anticoagulation interrupted 4 days prior to procedure^[3]; reinitiation of antiacoagulation with loading dose of warfarin may contribute to risk
- hypertension may be risk factor^[2]
- number of polyps & male sex increases risk^[3]

reversal of anticoagulation
- may not be necessary for polyps < 1 cm in size^[1]
- not necessary in most cases of postpolypectomy bleeding associated with direct oral anticoagulants regardless of polyp size^[5]
withholding clopidogrel unnecessary prior to polypectomy of smaller polyps^[4]
aspirin does not need to be discontinued regardless of polyp size^[5]

↑ ^1.0 ^1.1 Friedland S, Soetikno R. Colonoscopy with polypectomy in anticoagulated patients. Gastrointest Endosc. 2006 Jul;64(1):98-100. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16813811
↑ ^2.0 ^2.1 Watabe H, Yamaji Y, Okamoto M, Kondo S, Ohta M, Ikenoue T, Kato J, Togo G, Matsumura M, Yoshida H, Kawabe T, Omata M. Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc. 2006 Jul;64(1):73-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16813806
↑ ^3.0 ^3.1 ^3.2 Witt DM et al Incidence and predictors of bleeding or thrombosis after polypectomy in patients receiving and not receiving anticoagulation therapy. J Thromb Haemost 2009 Dec; 7:1982 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19719825
↑ ^4.0 ^4.1 Chan FKL et al. Risk of post-polypectomy bleeding with uninterrupted clopidogrel therapy in an industry-independent, double-blind, randomized trial. Gastroenterology 2018 Oct 25; PMID: https://www.ncbi.nlm.nih.gov/pubmed/21455672 https://www.gastrojournal.org/article/S0016-5085(18)35193-X/pdf
↑ ^5.0 ^5.1 ^5.2 Medical Knowledge Self Assessment Program (MKSAP) 18, 19. American College of Physicians, Philadelphia 2018, 2021