Gastrointestinal bleeding: optimising peri-endoscopic management

This thesis evaluated two aspects of gastrointestinal bleeding. Firstly, three areas of colonoscopic post-polypectomy bleeding were studied: cold snare polypectomy of 10-20mm colonic polyps appears safe, prophylactic endoscopic clip closure following uncomplicated polypectomy is unnecessary and cold snare polypectomy of subcentimetre polyps on clopidogrel with clip closure may mitigate risks of post-procedural bleeding. Secondly, an algorithm to extract gastrointestinal bleeding cases from the Australian and New Zealand Massive Transfusion Registry allowed critical peptic ulcer bleeding to be studied. Age, co-morbidities, INR, platelet count and creatinine were associated with 30-day mortality rather than blood product and therapeutic interventions.