| Postpolypectomy coagulation syndrome | |
|---|---|
| Other names | Transmural burn syndrome, Postpolypectomy syndrome Coagulation syndrome |
| Specialty | Gastroenterology |
| Symptoms | Abdominal pain, fever |
| Usual onset | 1-5 days after polypectomy |
| Causes | Polypectomy during colonoscopy |
| Risk factors | Hypertension, right colon polypectomy, large polyp size (>2 cm), non-polypoid lesions (laterally spreading lesions) [1] |
| Differential diagnosis | Perforation |
| Prevention | Antibiotic prophylaxis [2] |
| Treatment | IV fluids, antibiotics, nothing by mouth |
| Prognosis | Excellent |
| Frequency | 1% [1] |
Postpolypectomy coagulation syndrome (Postpolypectomy syndrome or PPCS) is a condition that occurs following colonoscopy with electrocautery polypectomy, which results in a burn injury to the wall of the gastrointestinal tract. The condition results in abdominal pain, fever, elevated white blood cell count and elevated serum C-reactive protein.
Signs and symptoms
PPCS causes abdominal pain and fever. [3] The condition usually onsets within 1–5 days after colonoscopy with polypectomy using electrocautery. [3] Physical examination may show evidence of peritonitis. [3]
Etiology
PPCS is caused by an electrocautery-induced injury to the wall of the colon that occurs during removal of colon polyps. [3] PPCS occurs when the electric current extends beyond the mucosa, entering the muscularis propria and serosa, resulting in a full thickness (transmural) burn injury. [1] The transmural burn results in localized inflammation of the peritoneum (peritonitis). [3]
Diagnosis
PPCS may resemble perforation. Recognition of PPCS is important, since treatment usually does not require surgery, unlike gastrointestinal perforation. Laboratory studies may show elevated white blood cell count ( leukocytosis) and elevated inflammatory markers such as C-reactive protein. CT scan of the abdomen may show severe mural thickening, without air present outside the gastrointestinal tract. [4]
Treatment
Treatment of PPCS consists of intravenous fluids, antibiotics, and avoiding any oral intake of food, water, etc. until symptoms improve. [3]
Prevention
Some low quality evidence suggests that antibiotic prophylaxis may prevent PPCS. [2]
Epidemiology
PPCS occurs about 1% of cases following polypectomy with electrocautery. [5] [1] Risk factors for PPCS include right colon polypectomy, large polyp size (>2 cm), non-polypoid lesions (laterally spreading lesions), and hypertension. [1]
References
- ^ a b c d e Hirasawa, K; Sato, C; Makazu, M; Kaneko, H; Kobayashi, R; Kokawa, A; Maeda, S (10 September 2015). "Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments". World Journal of Gastrointestinal Endoscopy. 7 (12): 1055–61. doi: 10.4253/wjge.v7.i12.1055. PMC 4564832. PMID 26380051.
- ^ a b La Regina, D; Mongelli, F; Fasoli, A; Lollo, G; Ceppi, M; Saporito, A; Garofalo, F; Di Giuseppe, M; Ferrario di Tor Vajana, A (2020). "Clinical Adverse Events after Endoscopic Resection for Colorectal Lesions: A Meta-Analysis on the Antibiotic Prophylaxis". Digestive Diseases (Basel, Switzerland). 38 (1): 15–22. doi: 10.1159/000502055. PMID 31408875. S2CID 199573818.
- ^ a b c d e f Kim, HW (May 2014). "What Is Different between Postpolypectomy Fever and Postpolypectomy Coagulation Syndrome?". Clinical Endoscopy. 47 (3): 205–6. doi: 10.5946/ce.2014.47.3.205. PMC 4058534. PMID 24944980.
- ^ Shin, YJ; Kim, YH; Lee, KH; Lee, YJ; Park, JH (October 2016). "CT findings of post-polypectomy coagulation syndrome and colonic perforation in patients who underwent colonoscopic polypectomy". Clinical Radiology. 71 (10): 1030–6. doi: 10.1016/j.crad.2016.03.010. PMID 27085213.
- ^ Waye, JD (June 1993). "Management of complications of colonoscopic polypectomy". The Gastroenterologist. 1 (2): 158–64. PMID 8049888.