HEMORRHAGIC RISK IN POST AMPULLECTOMY PATIENTS ON ANTITHROMBOTIC THERAPY

Aims Endoscopic ampullectomy (EA) can cure ampullary adenomas. However, the morbidity remains high including 10% risk of bleeding .The primary objective of this single-centre study was to determine whether patients treated with antiplatelet or anticoagulant therapy (VKA) had increased morbidity or mortality risk.

Methods Between May 1999 and June 2019, 309 patients treated by EA for an ampullary tumor were included prospectively in a database. For patients on antithrombotic treatment, therapy was systematically suspended following a predetermined protocol. Post-procedure bleeding was considered significant if there was clinical evidence or a drop in hemoglobin > 2g/dL.

Results Of the 309 patients, 45 (14.5%) (Group A) were taking an antithrombotic drug (15 antiplatelet treatment, 28 VKA, 2 others); 264 (85.4%) patients (Group B) were not on antithrombotic treatment. Both groups were comparable in terms of lesion size, the presence of a laterally spreading tumor component, the presence of adenocarcinoma on the histological report and the use of preventative measures for hemostasis. The mortality was 0.3% (n=1), due to perforation following hemostatic procedure. Overall morbidity was 24.6%, with a statistically significant (p< 0.02) greater risk in Group A (44%) compared with Group B (21%). There was no significant difference between the two groups in the rate of non-hemorrhagic complications. Bleeding complications were significantly more frequent (p=0.001) in Group A: 14 (32%) versus 31 (11.7%) in Group B. In all cases bleeding resolved with observation or repeat endoscopic treatment. The average length of stay was significantly higher in Group A (p = 0.03).

Conclusions In this study, patients undergoing antithrombotic treatment had significantly higher rates of secondary bleeding, transfusion and haemostatic endoscopic procedures after EA, but did not demonstrate a higher risk of non-hemorrhagic complications or mortality compared to patients not on antithrombotic drugs. EA remains a valid alternative treatment to surgical resection for patients on antithrombotic drugs.