The Risk of Endoscopic Mucosal Resection in the Setting of Clopidogrel Use

Objective . Guidelines on antiplatelet medication use during endoscopy are based on limited evidence. We investigate the risk of bleeding and ischemic events in patients undergoing endoscopic mucosal resection (EMR) of esophageal lesions in the setting of scheduled cessation and prompt resumption of clopidogrel. Design . Single centre retrospective review. Patients . Patients undergoing EMR of esophageal lesions. Interventions . Use of clopidogrel before EMR and resumption after EMR. Patients cease antiplatelets and anticoagulants 7 days before EMR and resume clopidogrel 2 days after EMR in average risk patients. Main Outcomes . Gastrointestinal bleeding (GIB) and ischemic events (IE) within 30 days of EMR. Results . 798 patients underwent 1716 EMR. 776 EMR were performed on patients on at least 1 antiplatelet/anticoagulant (APAC). 17 EMR were performed following clopidogrel cessation. There were 14 GIB and 2 IE. GIB risk in the setting of recent clopidogrel alone (0%) was comparable to those not on APAC (1.1%) ( P = 1.0). IE risk on clopidogrel (6.3%) was higher than those not on APAC (0.1%) ( P = 0.03). Limitations . Retrospective study. Conclusions . Temporary cessation of clopidogrel before EMR and prompt resumption is not associated with an increased risk of gastrointestinal bleeding but may be associated with increased ischemic events.