Prophylactic argon plasma coagulation ablation does not decrease delayed postpolypectomy bleeding

Abstract

BACKGROUND: The most common complication of colonoscopic polypectomy is postpolypectomy bleeding (PPB). However, there are no established guidelines for the prevention of delayed PPB. It is possible that submucosal vessels of an artificial ulcer are a potential source of delayed bleeding that occurs several days after polypectomy. OBJECTIVE: The aim of this randomized, controlled study was to evaluate the efficacy of prophylactic argon plasma coagulation (APC) of nonbleeding visible vessels in preventing delayed PPB. DESIGN: A prospective, randomized, controlled study. SETTING: A tertiary referral center. PATIENTS: A total of 987 polyps in 600 consecutive patients were resected by colonoscopic polypectomy. INTERVENTION: In patients who underwent APC (APC group), all nonbleeding visible vessels on the ulcer crater were targeted and were then coagulated by APC ablation until they disappeared, but not in patients who did not undergo APC (control group). MAIN OUTCOME MEASUREMENT: The incidence of delayed PPB in the APC group was compared with that in the control group. RESULTS: Delayed PPB occurred in 3.3% (16/475) of all the patients, including 2.5% (6/240) in the APC group and 4.3% (10/235) in the control group. No significant differences were observed between the 2 groups in the rates of delayed PPB, irrespective of the type of delayed bleeding (significant bleeding: 0.8% [2/240] vs 1.3% [3/235], P = .638; minor bleeding: 1.7% [4/240] vs 3% [7/235], P = .378). There were no significant APC-related complications. LIMITATION: Single-center study. CONCLUSION: Prophylactic APC ablation does not appear to have an additional advantage in the prevention of delayed PPB.