End-Stage Renal Disease Still Risk Factor for Colonoscopy Complications
Douglas K. Rex, MD, FASGE, reviewing Yang SC, et al. J Gastroenterol Hepatol 2020 Jan 3.
End-stage renal disease (ESRD) has been considered a risk factor for colonoscopy complications because of platelet dysfunction, in the case of bleeding, and perhaps tissue fragility, with regard to perforation.
In a study from Taiwan of postpolypectomy bleeding and polypectomy-related perforation from 1997 to 2013 involving 5302 ESRD patients and the same number of matched controls, the overall incidence of postpolypectomy bleeding or perforation was higher in the ESRD group (5.83% vs 1.78%). Also in the ESRD group, nonfatal complications requiring hospitalization were higher at 5.24% versus 1.51%, and fatal bleeding or perforation was 0.4% versus 0.2%. The odds ratio for bleeding or perforation after polypectomy in multivariable analysis was 2.38 for end-stage renal disease.
COMMENT
There have also been suggestions that diagnostic perforations are more common in ESRD, suggesting some reduction of tissue integrity. These data suggest that colonoscopists should feel confident that polypectomy is truly warranted before initiating tissue resection in ESRD patients and consider using cold techniques, when possible. Clip closure of large polyps removed thermally is probably reasonable, pending formal evaluation of its value in this population.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Douglas K. Rex, MD, FASGE
CITATION(S)
Yang SC, Wu CK, Tai WC, et al. Incidence and risk factors of colonoscopic post-polypectomy bleeding and perforation in patients with end-stage renal disease. J Gastroenterol Hepatol 2020 Jan 3. (Epub ahead of print) (https://doi.org/10.1111/jgh.14969)
