Yoshiyasu Kono1, Minoru Matsubara2, Tatsuya Toyokawa3, Ryuta Takenaka4, Seiyu Suzuki2, Junichirou Nasu5, Masao Yoshioka5, Masahiro Nakagawa6, Motowo Mizuno6,7, Hiroyuki Sakae8, Makoto Abe8, Tatsuhiro Gotoda8, Ko Miura8, Hiromitsu Kanzaki8, Masaya Iwamuro8, Keisuke Hori8, Takao Tsuzuki9, Masahide Kita10, Seiji Kawano8, Yoshiro Kawahara11, Hiroyuki Okada8. 1. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. hxnwq178@yahoo.co.jp. 2. Department of Internal Medicine, Sumitomo Bessi Hospital, Niihama, 792-8543, Japan. 3. Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, 720-8520, Japan. 4. Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama, 708-0841, Japan. 5. Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, 700-8551, Japan. 6. Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, 730-8518, Japan. 7. Department of Internal Medicine, Kurashiki Central Hospital, Kurashiki, 710-8602, Japan. 8. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. 9. Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, 670-8540, Japan. 10. Department of Internal Medicine, Okayama City Hospital, Okayama, 700-0833, Japan. 11. Department of Endoscopy, Okayama University Hospital, Okayama, 700-8558, Japan.
Abstract
BACKGROUND: The Japan Gastroenterological Endoscopy Society updated its guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment in July 2012. However, the safety of endoscopic procedures in antithrombotic drug users has not been fully investigated. AIMS: To evaluate the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users. METHODS: From September 2013 to September 2015, patients who were taking antithrombotic drugs and who underwent upper gastrointestinal endoscopic procedures were prospectively enrolled at five hospitals. Incidences of bleeding and thrombosis during endoscopic procedures were evaluated. RESULTS: A total of 270 patients [221 for endoscopic mucosal biopsy and 49 for endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) were enrolled. The bleeding rate was 0.9% for endoscopic mucosal biopsy and 22% for EMR/ESD, respectively. The bleeding rate after endoscopic mucosal biopsy was not significantly high, even if antithrombotic drugs were continued (0 vs. 1%, P > 0.99), while it was significantly higher among multiple antithrombotic drug users than single drug users (5.9 vs. 0%, P < 0.05). The bleeding rate after EMR/ESD was also higher among multiple antithrombotic drug users than single drug users, but was not significantly different (33 vs. 14%, P = 0.17). Moreover, there were no differences in bleeding rates according to the cessation or continuance of antithrombotic drugs (20 vs. 25%, P = 0.74). There were no thromboembolisms in all cases. CONCLUSIONS: Upper gastrointestinal endoscopic procedures performed under the new guidelines appear acceptable. However, endoscopic procedures among multiple antithrombotic drug users show a greater potential for bleeding.
BACKGROUND: The Japan Gastroenterological Endoscopy Society updated its guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment in July 2012. However, the safety of endoscopic procedures in antithrombotic drug users has not been fully investigated. AIMS: To evaluate the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users. METHODS: From September 2013 to September 2015, patients who were taking antithrombotic drugs and who underwent upper gastrointestinal endoscopic procedures were prospectively enrolled at five hospitals. Incidences of bleeding and thrombosis during endoscopic procedures were evaluated. RESULTS: A total of 270 patients [221 for endoscopic mucosal biopsy and 49 for endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) were enrolled. The bleeding rate was 0.9% for endoscopic mucosal biopsy and 22% for EMR/ESD, respectively. The bleeding rate after endoscopic mucosal biopsy was not significantly high, even if antithrombotic drugs were continued (0 vs. 1%, P > 0.99), while it was significantly higher among multiple antithrombotic drug users than single drug users (5.9 vs. 0%, P < 0.05). The bleeding rate after EMR/ESD was also higher among multiple antithrombotic drug users than single drug users, but was not significantly different (33 vs. 14%, P = 0.17). Moreover, there were no differences in bleeding rates according to the cessation or continuance of antithrombotic drugs (20 vs. 25%, P = 0.74). There were no thromboembolisms in all cases. CONCLUSIONS:Upper gastrointestinal endoscopic procedures performed under the new guidelines appear acceptable. However, endoscopic procedures among multiple antithrombotic drug users show a greater potential for bleeding.
Authors: Sun-Young Lee; Shou-jiang Tang; Don C Rockey; Douglas Weinstein; Luis Lara; Jayaprakash Sreenarasimhaiah; Kyoo Wan Choi Journal: Gastrointest Endosc Date: 2008-04-02 Impact factor: 9.427
Authors: Joon Young Choi; Young Soo Park; Gyeongjae Na; Sung Jae Park; Hyuk Yoon; Cheol Min Shin; Nayoung Kim; Dong Ho Lee Journal: Medicine (Baltimore) Date: 2019-08 Impact factor: 1.817