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A Journal on Forensic Medicine
Minerva Medicolegale 2011 September;131(3):75-85
Post-endoscopic polypectomy bleeding: casuistic contribution and forensic analysis
Marinelli E., Lauricella M. A., Zaami S.
Dipartimento di Scienze Anatomiche, Istologiche, Medicolegali e dell’Apparato Locomotore, Università degli Studi di Roma, “La Sapienza”, Roma, Italia
The endoscopic removal of precancerous colon lesions had a significant impact on the interruption of the adenoma-carcinoma sequence. The decision to perform a polypectomy is taken often during colonoscopy, when a polyp is evidenced, according to the rule that all potential adenomas must be removed. The appearance and size of a polyp doesn’t necessarily represent true indicators of its histological nature, but they still influence the technique of execution that, despite progress over the last decade, isn’t without complications, even severe, including hemorrhagic complications. Many endoscopic procedures aimed at removing the polyps are in fact associated with a higher risk of bleeding. This risk is significantly increased in subjects who, because of associated comorbid conditions, are on chronic oral anticoagulants the-rapy. In fact, in these patients must be carefully weighed the risk of bleeding related to endoscopic procedures with the risk of thromboembolic events associated with the possible suspension of treatment. Our contribution proposes a medical-legal examination on rules of conduct dictated by the most recent guidelines and operational protocols developed by the scientific community, inspired by a case of endoscopic polypectomy complicated by bleeding, which has given rise to a litigation resolved with the recognition of medical liability.