This case involves a 71-year-old male patient who visited a gastroenterologist for a routine colonoscopy. During the colonoscopy, a large sessile serrated lesion was found. The patient received a hot snare polypectomy procedure for treatment of the lesion and was subsequently discharged. Post-operatively, at home, the patient developed rectal bleeding which caused him to faint. The patient fell backward, causing severe hip injuries as well as a traumatic brain injury. The patient was taken for emergency surgery for his traumatic brain injury but died post-operatively.
Question(s) For Expert Witness
- 1. How often do you perform colonoscopies?
- 2. How often do you perform hot snare polypectomy procedures?
- 3. What should be done to prevent sending a patient home with rectal bleeding?
Expert Witness Response E-096088
I have extensive gastroenterology experience, and I perform about 15 colonoscopies per week. I perform hot snare polypectomy procedures several times per week as well, as it is a very common modality for removing polyps. I also perform cold snare and biopsy polypectomies. Post-polypectomy bleeding is a known complication of a colonoscopy with polypectomy. This risk should be discussed in the process of obtaining consent. There are several ways to minimize the risk of bleeding. These include identifying who is at risk for bleeding, using the cold snare technique for smaller polyps (less than 1cm), holding anti-platelet/anti-coagulation medication before and/or after the procedure, treating active bleeding during the procedure, and empirically placing hemostatic clips on post-polypectomy sites, among others.