Premium
Postoperative bleeding risk after gastric endoscopic submucosal dissection during antithrombotic drug therapy
Author(s) -
Kono Yoshiyasu,
Obayashi Yuka,
Baba Yuki,
Sakae Hiroyuki,
Gotoda Tatsuhiro,
Miura Ko,
Kanzaki Hiromitsu,
Iwamuro Masaya,
Kawano Seiji,
Kawahara Yoshiro,
Tanaka Takehiro,
Okada Hiroyuki
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13872
Subject(s) - medicine , antithrombotic , cilostazol , aspirin , clopidogrel , odds ratio , antiplatelet drug , surgery , gastroenterology
Abstract Background and Aim The safety of gastric endoscopic submucosal dissection (ESD) in the antithrombotic drug users remains controversial. Methods Patients who underwent gastric ESD at Okayama University Hospital between March 2006 and February 2016 were enrolled. This study investigated the risk of post‐ESD bleeding according to the management of the antithrombotic drugs. Results One thousand twenty lesions (872 patients) were enrolled. In a multivariate analysis, heparin replacement (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.8–14), multiple antithrombotic drug use (OR 2.9, 95% CI 1.1–6.9), a resected specimen of ≥ 33 mm in diameter (OR 2.7, 95% CI 1.5–5.4), Helicobacter pylori negativity (OR 2.2, 95% CI 1.3–3.7), and tumors located in the lower third of the stomach (OR 1.7, 95% CI 1.0–2.9) were significant risk factors for post‐ESD bleeding, while the continuation of aspirin or cilostazol was not (OR 2.6, 95% CI 0.72–7.8). The bleeding rate of the continuation group was comparable with that of the all cessation group among single antithrombotic drug users (4.5% vs 4.4%, P = 1.0); however, the rate of the continuation group was significantly higher than that of the all cessation group among multiple antithrombotic drug users (67% vs 15%, P = 0.020). Conclusions The risk of post‐ESD bleeding differed according to the management of the antithrombotic drugs. The gastric ESD under the cessation or continuation of aspirin or cilostazol monotherapy was acceptable. However, multiple antithrombotic drug use or heparin replacement was associated with a higher risk of post‐ESD bleeding.