postpolypectomy

Postpolypectomy refers to the period after removal of colorectal polyps during colonoscopy, encompassing healing as well as potential complications such as bleeding, perforation, postpolypectomy syndrome, and infection.

Most endoscopic polypectomies are uneventful. Risk factors for adverse events include polyp size (larger polyps), morphology (sessile or pedunculated), location (the right colon carries higher risk), and the resection method (hot techniques). Antithrombotic therapy also increases the risk of bleeding.

Postpolypectomy bleeding may be immediate, during the procedure, or delayed, within days to a couple of weeks. Symptoms include hematochezia, lightheadedness, or hypotension. Management typically involves endoscopic hemostasis with clips, cautery, or injection; hospital observation; and transfusion if needed. Anticoagulation therapy is resumed according to local guidelines.

Postpolypectomy syndrome is a localized inflammatory response after mucosal or submucosal resection, causing abdominal pain, fever, and leukocytosis without perforation. Management is supportive: IV fluids, analgesia, and close monitoring; antibiotics are considered if infection is suspected or symptoms worsen.

Perforation is rare but serious. Symptoms include sudden severe abdominal pain and signs of peritonitis; diagnosis is via imaging. Immediate management requires surgical evaluation and typically prompt repair, sometimes with endoscopic closure if recognized early.

Prevention and surveillance: cold snare polypectomy for small polyps reduces thermal injury; appropriate technique and polyp selection are important. Prophylactic clipping may be used for large stalked polyps. Anticoagulants are managed per guidelines. Post-procedure instructions and standard surveillance colonoscopy intervals apply based on polyp findings and histology.