Patients with liver cirrhosis are considered at increased risk for bleeding complications after endoscopic procedures due to impaired haemostasis. However, evidence-based risk stratification for colorectal polypectomy in this population remains limited. This study aimed to identify cirrhosis-specific and universal risk factors for post-polypectomy bleeding by comparing patients with liver cirrhosis to matched non-cirrhotic controls.

Data were retrospectively obtained for 285 patients, including 96 patients with liver cirrhosis who underwent colorectal polypectomy (polyps ≥5mm) between 2013-2023. Matching was performed by age, gender, and comorbidity index. The primary endpoint was any bleeding, secondary endpoints were intraprocedural bleeding, delayed bleeding, and other severe complications. Risk factors were analyzed using univariate logistic regression.

Universal risk factors across both groups included PTT (cirrhosis: ≥32.2s, OR 6.15, p=0.022; controls: ≥31s, OR 2.83, p=0.007), INR (cirrhosis: ≥1.3, OR 3.12, p=0.031; controls: ≥0.92, OR 3.24, p=0.023), and lower GOT values, which showed a paradoxical protective association in both groups (cirrhosis: ≥28 U/L, OR 0.22, p=0.029; controls: ≥28 U/L, OR 0.29, p=0.011). Cirrhosis-specific risk factors were spleen diameter ≥18cm (OR 3.89, p=0.026) and MELD score ≥15 (OR 3.27, p=0.044). In controls, polyp size ≥15mm was the strongest predictor (OR 4.69, p<0.01), while protective factors included platelet count >211×10⁹/μl (OR 0.42, p=0.022) and prothrombin activity ≥114% (OR 0.1, p=0,027). In the overall cohort analysis (n=285), polyp size emerged as the dominant risk factor (≥16mm: OR 4.26, p<0.01). Liver cirrhosis itself was not an independent predictor, and bleeding rates did not differ significantly between cirrhotic and non-cirrhotic patients.

Risk assessment for post-polypectomy bleeding should be individualized, not predetermined by cirrhosis status. Universal risk factors - PTT, INR and polyp size - apply across groups with different thresholds. Cirrhosis-specific markers like MELD and spleen size need targeted evaluation. Crucially, liver cirrhosis itself was not an independent bleeding risk factor. Our data suggest that safe polypectomy is achievable in well-selected cirrhosis patients and that bleeding risk may by further reduced using tailored risk stratification.