Screening colonoscopy with polypectomy has been shown to reduce the morbidity and mortality associated with colorectal cancer.
However, there is a lack of large and systematic prospective studies of the complications of polypectomy.
Dr Heldwein and colleagues prospectively recorded data on all snare polypectomies during a 20-month period, including 30-day follow-up data.
The procedures were performed in 6 hospitals and 7 gastroenterology offices.
The primary end points were polypectomy complications, which were classed as ‘major' or ‘minor'.
The researchers analyzed risk factors for complications for both patient characteristics and polyp parameters.
The research team included a total of 3976 snare polypectomies in 2257 patients with a mean age of 65 years.
|Right-sided polyp location was a risk factor for major complications |
The team noted that the mean polyp size was 1 cm, and that 72 % were sessile.
Complications occurred in 10 % of patients, and 75 % of these complications were minor.
The research team observed a zero mortality rate.
Multivariate regression analysis revealed polyp size as the main risk factor.
The team noted that this was both for complications overall, and for major complications.
Right-sided polyp location was a significant risk factor for major complications.
The team set a cut-off value of 3 % as an acceptable rate for major complications.
Based on the cut-off value, the team found that polyps larger than 1 cm in the right colon or 2 cm in the left colon carried an increased risk.
In addition, multiple polyps were found to carry an increased risk.
Dr Heldwein's team commented, “Colonoscopic polypectomy is associated with a 10 % rate of complications, but 75% of these are of minor clinical significance.”
“More than 90 % of the complications can be managed conservatively if adequate endoscopic expertise is available.”
“Guidelines for intensified follow-up after polypectomy should be based on the size, location, and number of a patient's polyps.”