University of Massachusetts Chan Medical School Worcester, MA
Nicholas Hebda, MD1, Katherine Cooper, MD1, Alessandro Colletta, MD1, Deepika Devuni, MD2 1University of Massachusetts Chan Medical School, Worcester, MA; 2University of Massachusetts Memorial Medical Center, Worcester, MA
Introduction: It is well established that colonoscopy with polypectomy can reduce mortality from colorectal cancer and is a routine component of liver transplant evaluation (LTE). Although colonoscopy is an overall safe procedure for patients with chronic liver disease, the risk of bleeding is elevated in patients with cirrhosis undergoing polypectomy. This poses a challenge to the management of polyps in patients with cirrhosis.
Methods: We performed a single-center retrospective analysis of patients who underwent screening colonoscopy within 6 months of initiation of LTE between October 2017 and July 2021. Colonoscopy data were collected directly from procedure reports. Patients were categorized as having undergone incomplete polypectomy if any polyp identified during the procedure was not completely removed, regardless of size. Backward logistic regression was used to identify predictors of incomplete polypectomy, with statistical significance set at p < 0.05.
Results: A total of 73 patients underwent initial screening colonoscopy within 6 months of initiation of LTE. 33 of these patients were noted to have colon polyps and, within this group, 45% (15/33) had incomplete polypectomies. The most common reasons cited for incomplete polypectomy were coagulopathy (n=4) and thrombocytopenia (n=3); however, INR (1.6 vs. 1.9, p=0.076) and mean platelet count (95 vs. 92, p=0.884) were not significantly different in patients with complete versus incomplete polypectomy. Patients with incomplete polypectomy had significantly higher MELD-Na scores (29.6 vs. 21.6, p=0.0027). On backward regression, MELD-Na score was identified as an independent predictor for incomplete polypectomy (p=0.041), while INR and platelet count were not.
Discussion: In a cohort of patients undergoing screening colonoscopy for LTE at our institution, MELD-Na score was identified as an independent predictor of incomplete polypectomy. INR and platelet count, despite being the two most cited reasons for deferring polypectomy, were not independent predictors of incomplete polyp resection.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Nicholas Hebda indicated no relevant financial relationships.
Katherine Cooper indicated no relevant financial relationships.
Alessandro Colletta indicated no relevant financial relationships.
Deepika Devuni: Massachusetts Department of Public Health – Grant/Research Support. National Institute on Alcohol Abuse and Alcoholism – Grant/Research Support. Sequana Medical – Grant/Research Support.
Nicholas Hebda, MD1, Katherine Cooper, MD1, Alessandro Colletta, MD1, Deepika Devuni, MD2. P2146 - Predictors of Incomplete Polypectomy in Patients Undergoing Screening Colonoscopy for Liver Transplant Evaluation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
