Is bleeding a normal occurrence after a colonoscopy with biopsy?

From the Guidelines

Bleeding after a colonoscopy with biopsy is a known complication, but most cases are minor and self-limiting, with a reported risk of 0.07%–1.7% for post-polypectomy bleeding (PPB) 1.

Overview of Bleeding Risk

The risk of bleeding is influenced by factors such as polyp size, use of pure cutting current, and the technique used for polypectomy.

• The use of cold snare polypectomy may reduce the risk of PPB compared to hot snare polypectomy, especially in patients on anticoagulant therapy 1.
• Patients on antiplatelet therapy, such as aspirin or clopidogrel, may have a slightly increased risk of PPB, but the risk is still considered low 1.
• The risk of bleeding is higher for larger polyps, with a reported risk of 1.14% for polyps of any size, and 0.08% for severe bleeding requiring transfusion 1.

Management of Bleeding

Most cases of bleeding after colonoscopy with biopsy are minor and can be managed conservatively.

• Patients should be advised to contact their doctor immediately if they experience heavy bleeding, persistent bleeding, severe abdominal pain, fever, or pass large blood clots.
• Prophylactic use of endoclips may be advisable for patients on antithrombotics undergoing endoscopic mucosal resection (EMR) due to the increased risk of PPB 1.
• The use of cold snare polypectomy and prophylactic clipping may help minimize the risk of PPB in patients on antiplatelet or anticoagulant therapy 1.

Patient Education

Patients should be informed about the risks and benefits of colonoscopy with biopsy, including the risk of bleeding.

• They should be advised to report any symptoms of bleeding, such as rectal bleeding, abdominal pain, or fever, to their doctor immediately.
• Patients on antiplatelet or anticoagulant therapy should be closely monitored for signs of bleeding after the procedure 1.

From the Research

Bleeding after Colonoscopy with Biopsy

Bleeding can occur after a colonoscopy with biopsy, but the risk is generally considered small.

• The risk of significant gastrointestinal bleeding after endoscopic biopsy or polypectomy is less than 1% 2.
• Minor, self-limited bleeding can occur in up to 6.3% of patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) and 2.1% of control patients 2.
• Aspirin use can increase the risk of bleeding after colonoscopy with biopsy, with a significant prolongation of colon bleeding time noted after aspirin ingestion 3.
• The use of aspirin is associated with an increased prevalence of post-polypectomy bleeding, with an odds ratio of 6.72 4.

Risk Factors for Bleeding

Certain factors can increase the risk of bleeding after colonoscopy with biopsy, including:

• Aspirin use 3, 4
• Polyp size 2
• Anticoagulation therapy 5
• Nonsteroidal anti-inflammatory drug (NSAID) use, although the evidence is mixed 2, 4

Management of Bleeding

Bleeding related to endoscopic biopsies is relatively uncommon and tends to be a self-limiting process.

• Current strategies for diagnosis, initial evaluation, and management of post-procedural bleed include thermal, mechanical, and chemical tools for local control, as well as interventional radiology or salvage surgery for more severe bleeds 5.