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CION Cancer Clinics
Perforation and bleeding after endoscopic resection | CION Cancer Clinics
Bleeding and perforation, meaning a hole in the wall of the bowel, stomach or food pipe, are the two main risks of an EMR or ESD. Both are uncommon, and most are found and dealt with during the procedure itself using clips through the scope. A few show up at home in the days after. This page explains what each looks like, what is done about it, and which signs mean you should not wait until morning. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- How serious are perforation and bleeding after EMR or ESD?
- What does each one look like, and when does it happen?
- What actually happens if a hole is found?
- Four things families believe about these complications, and what is true
- What to expect in the first two weeks, and what to ask
- Common questions about perforation and bleeding after endoscopic resection
The short answer
How serious are perforation and bleeding after EMR or ESD?
Bleeding and perforation, meaning a hole in the wall of the bowel, stomach or food pipe, are the two main risks of endoscopic resection. Both are uncommon, and most are recognised and dealt with during the procedure itself, with clips placed through the scope. A minority show up in the days afterwards, at home, which is why you are given a list of warning signs and a number to call.
Why these two, and not others
The resection works by lifting the growth off the muscle layer and cutting it away. Cut close to the surface and small vessels bleed. Cut too deep and the wall opens. The endoscopist works in the space between those two, which is why the wound is inspected carefully before the scope comes out.
Who is more at risk
Risk rises with larger growths, with ESD compared to EMR, with growths on the thin right side of the colon or in the food pipe, and with blood thinners such as aspirin, clopidogrel, warfarin or the newer tablets. Tell the team about every medicine before the day. Do not stop any of them on your own. Your cardiologist and endoscopist set the plan together.
What the page cannot tell you
It cannot tell you your own chance of either problem. That depends on the growth, the organ, the technique and your medicines.
Complication figures published for expert centres do not automatically apply to every unit. Ask yours how often these happen in their own hands.
!
Go to an emergency department the same day if
You pass a large amount of fresh blood or black tarry stool, vomit blood, feel faint or your heart races when you stand, or develop severe or steadily worsening abdominal or chest pain, a hard swollen belly, or a fever with chills. Say that you had an endoscopic resection and on what date. Do not wait until morning, and do not take a painkiller first to see whether it settles.
Not sure whether this applies to you?
Ask an oncologistThe two problems
What does each one look like, and when does it happen?
Each can happen during the procedure or in the days after. The timing changes how it is found and what is done.
Bleeding during the procedure
The commonest of the four. The endoscopist sees it and stops it on the spot with heat, clips or an injection. You will usually not know it happened unless you are told.
Delayed bleeding
The scab over the wound comes away, most often within the first two weeks. A little blood on the first stool is expected. Large amounts, clots, or black tarry stool are not.
More likely with
- Large growths and right-sided colon sites
- Blood thinners restarted after the procedure
- Straining, heavy lifting or long travel in the first days
Perforation during the procedure
A hole seen at the time. Most are small and are closed straight away with clips through the scope. You may be kept in overnight, kept off food for a while, and given antibiotics through a drip while the wall heals.
Delayed perforation
The rarest of the four. Deep heat damage weakens the wall and it gives way a day or more later. It shows as new severe pain, a hard belly and fever, and it needs a same-day CT scan and, sometimes, an operation to repair it.
If it happens
What actually happens if a hole is found?
Closing it through the scope
If seen during the procedure, clips are placed across the defect straight away. In many cases this is the whole treatment for the hole itself. The gas used to open the bowel is switched or released so that less escapes into the abdomen.
Rest, fluids and antibiotics
You stay in hospital, take nothing by mouth for a period, and have fluids and antibiotics through a drip. Your belly is examined regularly and bloods are checked for signs of infection.
A CT scan if there is doubt
If pain persists, the belly becomes tender or fever appears, a CT scan shows whether fluid or gas has collected outside the bowel and whether the clips are holding.
An operation only if needed
A small number of people need a keyhole or open operation to wash out the abdomen and repair or remove the damaged segment. A surgical oncologist is involved early, so the decision is not left until you are unwell.
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Commonly believed
Four things families believe about these complications, and what is true
"A hole in the bowel means the doctor was careless."
Perforation is a known risk of the technique, listed on every consent form, and it happens in expert hands too. What marks out a good unit is that it is recognised at once and closed, and that you are told about it plainly.
"Any blood after the procedure is an emergency."
A streak or a small amount on the first stool or two is expected and settles. A large amount, clots, black tarry stool, or feeling faint is different, and that is what the emergency list is for. The distinction is quantity and how you feel.
"If they kept him in overnight, something went badly wrong."
Many units keep people in after a large ESD, a right-sided colon resection, or when a small hole was clipped, purely to watch. It is a precaution, and it is usually a sign of a careful unit rather than a bad outcome.
"We should stop his blood thinner to be safe."
Stopping a blood thinner without advice can cause a stroke or a clot in a heart stent, which is far more dangerous than the bleeding it is meant to prevent. The pausing and restarting of these tablets is planned between your cardiologist and endoscopist. Never change them yourself.
Being straight with you
What to expect in the first two weeks, and what to ask
Most people go home the same day or the next morning, eat lightly for a day or two, and feel some bloating and mild cramping. That is the normal course. The wound inside is healing over that time, and the warning signs above are the ones that mean it is not healing as it should.
What lowers the risk at home
Avoid straining on the toilet, heavy lifting and long bumpy journeys in the first days, particularly after a large colon resection. Take the acid-suppressing tablets you are given after a stomach or food-pipe resection, because they protect the wound. Keep the discharge sheet and the number to call where the family can find them.
What to ask before you consent
Ask how often bleeding and perforation happen in this unit for a growth like yours. Ask whether a hole can be closed through the scope here, and whether a surgeon is on site if an operation is needed. Ask what the plan is for your blood thinner, and who will tell you when to restart it. Ask whom to call at night.
If you are already home and unsure whether what you are seeing is normal, call the helpline or the unit that did the procedure. Being told it is nothing is a good outcome.Questions we are asked
Common questions about perforation and bleeding after endoscopic resection
How much blood in the stool is normal after EMR?
A streak of red, or a small amount mixed in with the first one or two motions, is expected and settles on its own. Blood filling the pan, clots, repeated bloody motions, or black tarry stool are not normal. If you feel faint or your heart races when you stand, go to an emergency department the same day.
Can a perforation be fixed without an operation?
Often, yes. A hole seen during the procedure is usually closed with clips through the scope, followed by a hospital stay with antibiotics and a period without food. An operation is needed when the hole is large, was found late, or the abdomen has become infected. Your team will tell you which applies.
How many days after the procedure can bleeding still happen?
Most delayed bleeding happens within the first two weeks, when the scab over the wound comes away. It is uncommon after that, but not impossible, particularly if a blood thinner has been restarted. Keep the warning list until your endoscopist tells you the wound will have healed.
Is perforation more likely with ESD than EMR?
Yes, because ESD cuts deeper and takes longer, which is the price of removing the growth in one piece. Most ESD perforations are small and closed at the time. Your endoscopist should tell you the rates for their own unit, for the organ involved, before you consent.
Why do I have chest pain after a food-pipe resection?
Some soreness behind the breastbone on swallowing is common for a few days after a resection in the food pipe. Severe pain, pain that spreads to the neck or back, fever, or a crackling feeling under the skin of the neck is different, and needs same-day assessment because it can signal a hole.
When can I restart my blood thinner?
Only when the endoscopist and the doctor who prescribed it tell you, and the date depends on why you take it and how big the wound is. Someone with a recent heart stent is handled very differently from someone taking aspirin as a precaution. Ask for the restart date in writing before you leave.
Will a complication delay the pathology report or the next steps?
No. The specimen goes to the pathologist regardless, and the report is read at the same tumour board. What a complication may delay is the timing of any operation that follows, because the wall needs to heal first. Your surgeon sets that timing.
Is treatment of a complication covered by Aarogyasri or insurance?
Treatment of a complication arising from an approved procedure is usually covered, but schemes and insurers differ in how they handle an unplanned admission. Tell the hospital billing desk early, keep every document, and call the helpline if the approval is refused or delayed.
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Sources
- Cancer Research UK — Colonoscopy
- NHS — Colonoscopy
- American Cancer Society — Surgery for stomach cancer
- NICE — Colorectal cancer (NG151)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Eating and Recovery After Endoscopic ResectionWhat the normal first two weeks look likeStricture After Wide Endoscopic ResectionThe later complication after a wide resectionEMR and ESD ExplainedWhy ESD carries a higher perforation riskMedicines Around Cancer SurgeryBlood thinners and who decides when to pause themComplications and Red FlagsThe wider list of signs that need same-day care
Talk to us
Worried about something you are seeing after a resection?
Call the helpline or the unit that did the procedure. If it is an emergency, go to the nearest emergency department first and call us from there. A CION surgical oncologist can advise on what happens next.