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Post-polypectomy bleeding — ESEGH MCQ

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ModerateEndoscopyPost-polypectomy bleedingESEGH

A 70-year-old man develops significant haematochezia 6 hours after endoscopic mucosal resection of a 25 mm sessile polyp in the right colon. He is initially tachycardic but responds to intravenous fluid resuscitation. Repeat colonoscopy demonstrates active bleeding from a visible vessel at the resection base, with no evidence of perforation. What is the most appropriate immediate management?

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Correct answer: D — Endoscopic clip haemostasis, with cautious thermal coagulation if required

This is active early post-polypectomy bleeding from an identified EMR site. Endoscopic haemostasis is first-line: through-the-scope clips are generally preferred in the thin-walled right colon, with cautious low-energy thermal coagulation if clipping is unsuccessful or technically unsuitable. Observation is inappropriate because active bleeding is visible. CT angiography and embolisation are principally used when bleeding cannot be controlled or localised endoscopically, or when colonoscopy is not feasible. Emergency colectomy is reserved for bleeding uncontrolled by endoscopic and radiological intervention or for another surgical complication such as perforation. Terlipressin and antibiotics are used in suspected variceal upper gastrointestinal haemorrhage, not post-polypectomy bleeding.

Reference: British Society of Gastroenterology. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology, section ‘Post-polypectomy bleeding’, 2019. https://www.bsg.org.uk/getattachment/6d80aa64-9d11-4923-8789-a2e9b08502ef/gutjnl-2018-317807.pdf%3Flang%3Den-US