GASTRIC AND DUODENAL ENDOSCOPIC SUBMUCOSAL DISSECTION IN PATIENTS ON ASPIRIN THERAPY HAS INCREASED RISK OF HEMORRHAGE BUT IS FEASIBLE

TOUNOU Shigetaka, MORITA Yasushi

doi:10.11280/gee.53.3326

Recently, a sizable number of patients are taking anticoagulants and/or antiplatelet drugs. The Japanese guidelines on the management of endoscopic procedures in patients on anticoagulant and antiplatelet therapy recommend temporally discontinuation of anticoagulant and/or antiplatelet drugs in patients undergoing high risk endoscopic procedures. The problem is that some patients may meet serious life-threatening complication if they are forced to stop taking anticoagulants and/or antiplatelet drugs. In the present study, we investigated the occurrence of complications associated with endoscopic submucosal dissection (ESD) in patients taking various combinations of anticoagulant and antiplatelet drugs. We performed 232 ESDs for 219 patients with early gastric cancers and early duodenal cancers. In 152 patients who did not take anticoagulant nor antiplatelet drugs, postoperative hemorrhage was seen in 10 patients (6.6%), and 1 patient (0.7%) required blood transfusion. In 33 patients who had taken a single anticoagulant or antiplatelet drug and had stopped taking the drug before ESD, postoperative hemorrhage was seen in 4 patients (12.1%), and 3 patients (9.1%) required blood transfusion. In 12 patients who had taken more than 2 drugs and stopped all drugs before ESD, postoperative hemorrhage was seen in 1 patient (8.3%), and no patients (0.0%) required blood transfusion. In 7 patients who had taken a single drug and continued it (aspirin in all the cases), no postoperative hemorrhage was seen (0.0%), and no patients required blood transfusion (0.0%). In the remaining 15 patients who had taken more than 2 drugs and continued aspirin only, postoperative hemorrhage was experienced in 7 patients (46.7%), and 4 patients required blood transfusion (26.7%). In patients taking plural anticoagulants or antiplatelet drugs, the risk of postoperative hemorrhage was very high after re-starting these drugs. In contrast, in patients on aspirin therapy only, the risk of postoperative hemorrhage was low even if they continued aspirin therapy. According to the findings of this study, we conclude that ESD in patients on low-dose aspirin therapy only is safe, but when re-starting plural drugs, there is an increased risk of hemorrhage.

GASTRIC AND DUODENAL ENDOSCOPIC SUBMUCOSAL DISSECTION IN PATIENTS ON ASPIRIN THERAPY HAS INCREASED RISK OF HEMORRHAGE BUT IS FEASIBLE

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