Incidence and risk factors of colonoscopic post-polypectomy bleeding and perforation in patients with end-stage renal disease

Background and Aims: Colonoscopic polypectomy in end-stage renal disease (ESRD) patients are at risks of post-polypectomy bleeding and perforation, but evidences are limited. This study aimed to determine the incident polypectomy complications among ESRD patients. Methods: In the nationwide ESRD cohort, a propensity score matched case–control study design was conducted to assess risk associated with post-polypectomy bleeding and perforation using the Taiwanese National Health Insurance Research Database from 1997 to 2013 for adults aged 40 years and older; 7011 ESRD and 19 118 non-ESRD patients met the study criteria. A total of 5302 patients in each group were matched for further analyses. The primary endpoint was post-polypectomy bleeding or bowel perforation in 30 days. The secondary endpoint was mortality and length of hospital stay for the bleeding complications requiring hospitalization. Results: Overall incidences of post-polypectomy bleeding or perforation in patients with ESRD was higher than the non-ESRD group (5.83% vs 1.78%, P < 0.0001) in the matched cohort. High risk of adverse outcomes was associated with ESRD (adjusted odds ratio [aOR], 2.38, 95% confidence interval [CI], 1.85–3.05), female patient (aOR, 1.7, 95% CI, 1.37–2.11), history of acute myocardial infarction (aOR, 1.91, 95% CI, 1.1–3.32), liver disease (aOR, 1.79, 95% CI, 1.37–2.34), diabetes (aOR, 1.45, 95% CI, 1.16–1.82), cancer (aOR, 1.4, 95% CI, 1.09–1.81), inpatient setting (aOR, 13.19, 95% CI, 9.73–17.88), and prior use of clopidogrel (aOR, 1.61, 95% CI, 1.03–2.52) and warfarin (aOR, 2.03, 95% CI, 1.21–3.41). Conclusions: End-stage renal disease was associated with approximately twofold higher risk of colonoscopic post-polypectomy bleeding or perforation and should be cautiously performed in this special population cohort.