Postpolypectomy Coagulation Syndrome

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.

Postpolypectomy Coagulation Syndrome
Other namesTransmural burn syndrome,
Postpolypectomy Syndrome
Coagulation syndrome
SpecialtyGastroenterology
SymptomsAbdominal pain, fever
Usual onset1-5 days after polypectomy
CausesPolypectomy during colonoscopy
Risk factorsHypertension, right colon polypectomy, large polyp size (>2 cm), non-polypoid lesions (laterally spreading lesions)[1]
Differential diagnosisPerforation
PreventionAntibiotic prophylaxis[2]
TreatmentIV fluids, antibiotics, nothing by mouth
PrognosisExcellent
Frequency1%[1]

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
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Waye, JD (June 1993). "Management of complications of colonoscopic polypectomy". The Gastroenterologist. 1 (2): 158–64. PMID 8049888.
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