{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 30, Ep 4 of 5: Post-Polypectomy Adverse Events","html":"","width":"100%","height":180,"duration":393,"description":"Episode four teaches the post-polypectomy adverse event set through mechanism, because each event has a distinct anatomic or thermal correlate that determines the next move. Immediate bleeding is treated at the visible vessel while delayed bleeding returns for endoscopic hemostasis on the still-recognizable scar, and the prophylactic-clip decision turns on proximal location and antithrombotic risk rather than reflex. Perforation forces a closure decision driven by defect age and size, while post-polypectomy electrocoagulation syndrome mimics perforation but lacks free air and resolves on bowel rest. The unifying frame is that the recognition cue tells you the mechanism and the mechanism tells you the response, so hematochezia, free air, focal peritonitis without free air, and left shoulder pain are not interchangeable.\n \nTopics covered\n\nImmediate versus delayed post-polypectomy bleeding\nEndoscopic hemostasis modalities\nThe prophylactic-clip decision\nPerforation rates and recognition\nEndoscopic closure versus surgery\nPost-polypectomy electrocoagulation syndrome\nSplenic injury and the Kehr sign\n \n \nKey decisions\n\nImmediate bleeding at the polypectomy site is managed at the visible vessel with hemoclips, snare-tip or forceps coagulation, or epinephrine paired with a definitive modality, while delayed bleeding at one to fourteen days returns for repeat colonoscopy with hemostasis on the recognizable scar.\nProphylactic clip closure of large proximal EMR defects reduces delayed bleeding with a number needed to treat around ten in patients on antithrombotics or with proximal lesions over twenty millimeters, but routine closure of small left-sided defects off antithrombotics is not standard.\nA fresh perforation under two centimeters recognized during the procedure can be closed endoscopically with through-the-scope clips, over-the-scope clips, or suturing with success above ninety percent.\nLarger defects, older perforations, established peritoneal contamination, or poor...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}