Frequency and Predictors of Post-Polypectomy Syndrome in Patients Undergoing Endoscopic Polypectomy
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/079Keywords:
Post-polypectomy syndrome (PPS), Endoscopic polypectomy, Colonic polyps, , Polyp size, Endoscopic mucosal resection (EMR)Abstract
Background:
Post-polypectomy syndrome (PPS) is a recognized complication of endoscopic polypectomy, presenting with abdominal pain, fever, and localized peritoneal irritation in the absence of perforation. Understanding its frequency and risk factors is crucial for improving procedural safety and patient outcomes.
Objective: To determine the frequency of PPS and identify its predictors in patients undergoing endoscopic polypectomy.
Methods: This cross-sectional study included 500 patients who underwent endoscopic polypectomy. Patient demographics, polyp characteristics (size, location, histology), and procedural details (polypectomy technique, prophylactic clipping, insufflation method) were analyzed. The incidence of PPS was determined, and risk factors were assessed using multivariate logistic regression.
Results: The overall frequency of PPS was 5%. Larger polyp size (>2 cm), right-sided colonic location, and advanced polypectomy techniques (endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD)) were significantly associated with a higher risk of PPS (p < 0.05). Use of prophylactic clipping and CO₂ insufflation was associated with a lower incidence of PPS.
Conclusion: PPS occurs in 5% of patients undergoing endoscopic polypectomy, with larger polyp size and advanced techniques being key predictors. Preventive measures, including prophylactic clipping and CO₂ insufflation, may reduce the risk. These findings contribute to improving post-polypectomy safety and patient care strategies.
Post-polypectomy syndrome, Endoscopic polypectomy, Endoscopic mucosal resection (EMR),Endoscopic submucosal dissection (ESD),Colonic polyps, Gastrointestinal endoscopy.
References
References
1,Winawer SJ, Zauber AG, Ho MN, O'Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993;329(27):1977-81.
2,Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366(8):687-96.
3,Waye JD, Lewis BS, Yessayan S. Colonoscopy: a review of its limitations and complications. Gastroenterology. 1976;71(4):603-13.
4,Kim HS, Kim TI, Kim WH. Risk factors for post-polypectomy coagulation syndrome following endoscopic resection of colorectal polyps: a systematic review. World J Gastroenterol. 2020;26(32):4758-71.
5,Castro G, Azpiroz F, Malagelada JR. Abdominal pain in colonic diseases: Pathogenesis and treatment. Am J Gastroenterol. 2000;95(10):2815-27.
6,Lee SH, Chung IK, Kim SJ, Kim JO, Ko BM, Hwangbo Y, et al. Risk factors for delayed post-polypectomy bleeding in patients with colorectal polyps: a multicenter study. Am J Gastroenterol. 2013;108(8):1133-41.
7,Singal AK, Gupta R, Bharadwaj S. Post-polypectomy syndrome: A review of incidence, predictors, and preventive strategies. Clin Gastroenterol Hepatol. 2015;13(7):1277-83.
8,Repici A, Pellicano R, Strangio G, Barbon V, Danese S, Malesci A, et al. Endoscopic mucosal resection: a review of outcomes and complications in colorectal lesions. Gastrointest Endosc. 2012;75(5):954-65.
9,Cappell MS. Safety and efficacy of endoscopic mucosal resection for treating colorectal lesions: a systematic review. Dig Dis Sci. 2015;60(8):2061-72.
10,Yang DH, Park CH, Kim HS, Kim JW, Cho YK, Kim KO, et al. Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasia: a multicenter study. Gut Liver. 2015;9(6):843-9.
11,Sidhu M, Tate DJ, Desomer L, Brown GJ, Hourigan LF, Singh R. Prophylactic clip closure of the mucosal defect to prevent delayed bleeding after endoscopic mucosal resection. Gastrointest Endosc. 2021;93(4):819-27.
12, Nagata N, Kobayashi K, Tominaga K, Sakurai T, Akiyama J, Shimbo T, et al. Effect of CO₂ insufflation during colonoscopy on incidence of post-polypectomy syndrome. Am J Gastroenterol. 2016;111(4):607-16.
13,Kobayashi K, Nagata N, Sakamoto K, Shimbo T, Akiyama J, Uemura N. Clinical predictors of post-polypectomy syndrome: a multicenter study. Endoscopy. 2019;51(8):763-70.
14,Yamashina T, Nemoto D, Hayashi Y, Shimodate Y, Yoshikawa K, Matsui T, et al. Incidence and risk factors of post-polypectomy syndrome after colorectal polypectomy: a prospective study. Endoscopy. 2020;52(5):383-90.
15,Seo M, Song EM, Kim SE, Park CH, Shin JE, Lee SH. Colorectal polypectomy-related complications and their predictors: a large multicenter study. Clin Endosc. 2021;54(2):172-9.
16,Luigiano C, Consolo P, Scaffidi M, Strangio G, Giacobbe G, Barresi L, et al. Endoscopic snare resection vs. EMR for large colorectal polyps. World J Gastroenterol. 2016;22(12):3512-20.
17,Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, et al. Colorectal cancer screening: recommendations for clinical practice. Am J Gastroenterol. 2017;112(7):1016-30.
18,Hassan C, Quintero E, Dumonceau JM, Regula J, Brandão C, Chaussade S, et al. Post-polypectomy colorectal cancer incidence: A European multicenter study. Gastroenterology. 2012;143(4):844-53.
19,Kume K, Yamasaki M, Yoshikawa I, Otsuki M. Prevention of post-polypectomy syndrome: insights from clinical studies. World J Gastrointest Endosc. 2014;6(7):301-8.
20,Matsumoto M, Kato M, Yamamoto K, Yokota H, Shiratori K. Prevention of post-polypectomy syndrome using prophylactic clipping: A prospective controlled study. J Clin Gastroenterol. 2017;51(5):417-23.
21,Van Stolk RU, Sivak MV Jr, Petras RE, et al. Complications of large colonoscopic polypectomy. Gastroenterology. 1991;100(1):64-66.
22,Taha AS, Nakshabendi I, Lee FD, et al. Risk of post-polypectomy syndrome in patients undergoing large colonic polyp removal. Endoscopy. 1997;29(7):593-597.
23, Matsuda T, Saito Y, Hotta K, et al. Prevention of complications in colonoscopy. World J Gastroenterol. 2015;21(15):4352-4361.
24, Singh H, Turner D, Xue L, et al. Efficacy of prophylactic clipping in post-polypectomy syndrome: a meta-analysis. Am J Gastroenterol. 2016;111(8):1122-1131.
25, Gkolfakis P, Tziatzios G, Dimitriadis GD, et al. The impact of patient-related factors on post-polypectomy complications. Dig Dis Sci. 2022;67(3):839-849.
26, Lee HS, Kim KY, Cho JH, et al. Role of comorbid conditions in the development of post-polypectomy syndrome. J Gastroenterol Hepatol. 2020;35(4):635-640.
27,Strate LL, Modi R, Cohen E, et al. Patient education and follow-up strategies for post-polypectomy complications. Clin Gastroenterol Hepatol. 2014;12(8):1239-1246.
28,Hassan C, Wysocki PT, Fuccio L, et al. Advances in post-polypectomy surveillance strategies. Gastrointest Endosc. 2021;94(4):705-719.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
