Efficacy, risk factors and complications of endoscopic polypectomy: Ten year experience at a single center

Table 1 Demographic and clinical data of the populations studied

	Total	Group 1	Group 2	Group 3	Group 4
Number of patients	1038	675	211	121	31
Age	65.9 ± 12.4	65.1 ± 12.9	67.1 ± 11.9	68.1 ± 10.3	71.9 ± 9.9
Sex
M/F	671/367	448/227	133/78	73/48	17/14
Drugs assumption
Aspirin or anticoagulant	22 (2.1%)	12 (1.77%)	6 (2.8%)	4 (3.3%)
Associated extra intestinal diseases
Cardiac diseases	70 (6.7%)	47 (6.96%)	13 (6.16%)	8 (6.6%)
Diabetes Mellitus	8 (0.7%)	8 (1.18%)
Chronic Renal Failure	11 (1.05%)	4 (0.6%)	4 (1.89%)	2 (1.65%)	1 (3.22%)
Neoplasms	32 (3.08%)	18 (2.6%)	8 (3.79%)	5 (4.1%)	1 (3.22%)
Liver diseases	34 (3.3%)	26 (3.85%)	5 (2.36%)	3 (2.47%)
Endocrinological diseases	1 (0.09%)	1 (0.14%)
Associated intestinal diseases
Diverticula	262 (25.2%)	188 (27.8%)	51 (24.1%)	17 (14.04%)	6 (19.3%)
CRC	112 (10.8%)	60 (8.88%)	36 (17.06%)	16 (13.2%)
IBD	31 (2.9%)	22 (3.25%)	8 (3.79%)	1 (0.8%)
Ischemic colitis	8 (0.7%)	7 (1.03%)		1 (0.8%)
Melanosis coli	10 (0.96%)	8 (1.18%)	2 (0.94%)
Emorroidi	39 (3.75%)	27 (4%)	9 (4.26%)	3 (2.47%)
Angiodysplasia	13 (1.25%)	12 (1.77%)	1 (0.47%)

Table 2 Characteristics of polyps resected according to size

	Total	Group 1	Group 2	Group 3	Group 4
Number of polypectomy	1354	907	287	129	31
Size (mm)	9.45 ± 9.56	4.8 ± 2.18	11.8 ± 2.6	27.7 ± 5.8	46.8 ± 13.02
Range	(1-100)	(1-10)	(11-19)	(20-39)	(40-100)
Shape
Pedunculated	388 (28.7%)	176 (19.4%)	135 (47%)	70 (54.3%)	7 (22.6%)
Sessile	966 (71.3%)	731 (80.6%)	152 (53%)	59 (45.7%)	24 (77.4%)
Location
Rectal	247 (18.3%)	146 (16.1%)	54 (18.8%)	33 (2.6%)	14(45.4%)
Sigmoid	559 (41.3%)	375 (41.3%)	119 (41.5%)	59 (45.7%)	6 (19.4%)
Left colon	184 (13.6%)	126 (13.9%)	44 (15.3%)	13 (10.1%)	1 (3.2%)
Splenic flexure	24 (1.8%)	14 (1.6%)	8 (2.8%)	1 (0.8%)	1 (3.2%)
Transverse	94 (6.9%)	69 (7.6%)	17 (5.9%)	6 (4.7%)	2 (6.4%)
Hepatic flexure	64 (4.7%)	45 (4.9%)	12 (4.2%)	3 (2.3%)	4 (12.8%)
Right colon	129 (9.5%)	95 (10.5%)	23 (8%)	9 (6.9%)	2 (6.4%)
Caecum	53 (3.9%)	37 (4.1%)	10 (3.5%)	5 (3.9%)	1 (3.2%)
Histology
Tubular adenoma	756 (55.9%)	596 (65.8%)	138 (48.1%)	19 (14.7%)	3 (9.7%)
Villous adenoma	243 (17.9%)	103 (11.3%)	48 (16.7%)	66 (51.2%)	26 (83.9%)
Tubulovillous adenoma	315 (23.3%)	174 (19.2%)	97 (33.8%)	42 (32.6%)	2 (6.4%)
Hyperplastic	40 (2.9%)	34 (3.7%)	4 (1.4%)	2 (1.5%)
Dysplasia
No	125 (9.2%)	117 (12.9%)	6 (2.1%)	2 (1.5%)
LGD	1078 (79.6%)	769 (84.8%)	245 (85.4%)	57 (44.2%)	7 (22.6%)
HGD	123 (9.1%)	17 (1.9%)	32 (11.1%)	51 (39.5%)	23 (74.2%)
Invasive cancer	28 (2.1%)	4 (0.4%)	4 (1.4%)	19 (14.8%)	1 (3.2%)
Technique of polypectomy
Direct snare	1294 (95.6%)	907 (100%)	255 (88.9%)	108 (83.7%)	24 (77.4%)
Mucosectomy	56 (4.1%)		30 (10.4%)	19 (14.8%)	7 (22.6%)
Endoloop	4 (0.3%)		2 (0.7%)	2 (1.5%)
Complication
Bleeding	17 (1.3%)	4 (0.4%)	3 (1.05%)	7 (5.4%)	3 (9.7%)
Perforation	1 (0.07%)		1 (0.35%)
Technique of hemostasis
Injection	13 (76.5%)	4 (100%)	2 (66.7%)	6 (85.7%)	1 (33.3%)
Clips	3 (17.6%)		1 (33.3%)		2 (66.7%)
APC	1 (5.9%)			1 (14.3%)

Table 3 Results of the Pearson χ² test applied in the sub-groups for evaluation of the association between bleeding and variables

	P-value
	Group 1	Group 2	Group 3	Group 4
Associated extra intestinal diseases
Liver diseases	0.003	0.060	0.001	0.851
Location
Transverse colon	0.0001	0.966	0.853	0.123
Histology
Hyperplastic polyp	0.238	0.023	0.912	0.125
Dysplasia
Invasive cancer	0.996	0.0001	0.681	0.561
Associated intestinal diseases
Colon rectal cancer	0.130	0.384	0.922	0.036

Table 4 Results of NPC test of the four groups examined in relationship with bleeding

	P-value
Group 1 vs Group 2	0.368
Group 1 vs Group 3	0.0001
Group 1 vs Group 4	0.001
Group 2 vs Group 3	0.012
Group 2 vs Group 4	0.013
Group 3 vs Group 4	0.407

Table 5 Results of the Binary Logistic regression

	Coef	SE Coef	Z	P
Associated extra intestinal diseases	0.635	0.11	5.77	0
Histology	0.509	0.226	2.26	0.024
Size	0.0567	0.019	2.97	0.003

Table 6 Recent reports of series on large polyp endoscopic resection and our series

Authors	Total (n)	Pedunculated (n)	Sessile (n)	Hemorrhage (%)	Perforation (%)	Other (%)
Brooker JC et al[3]	34	-	34	17.6	0	5.9
Hsieh YH et al[4]	13	-	13	0	0	0
Brooker JC et al[5]	100	-	100	3	0	1
Walsh RM et al[6]	117	-	117	8.5	0.8	0.8
Iishi H et al[7]	56	-	56	7	0	0
Zlatanic J et al[8]	77	-	77	6.5	1.3	0
Kanamori T et al[9]	33	-	33	9.1	0	0
Boix J et al[10]	74	-	74	13.5	0	0
Bedogni G et al[11]	66	20	42	3.1	0	1.5
Binmoeller K et al[12]	176	47	129	24	0	0
Webb WA et al[13]	102	72	30	7.8	0	0
Nivatvongs S et al[14]	280	196	84	0.7	0	1.8
Perenz RF et al[15]	147	73	74	5.4	1.3	0
Dell’Abate P et al[16]	104	49	55	3.8	0	0
Jameel JK et al[17]	30	6	24	6.1	0	0
Doniec JM et al[18]	186	45	141	15	0.5	0
Stergiou N et al[19]	68	27	41	22.1	0	0
Consolo P et al	160	77	83	6.2	0	0