Endoscopy 2019; 51(04): S40
DOI: 10.1055/s-0039-1681288
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ESD stomach 1 Club A
Georg Thieme Verlag KG Stuttgart · New York

IMPACT OF ANTIPLATELET USE ON THE RISK OF BLEEDING AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC ADENOMA AND EARLY GASTRIC CANCER

YW Chang
1   Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea, Republic of
,
JY Jang
1   Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea, Republic of
,
JW Kim
1   Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea, Republic of
,
SW Han
2   Gastroenterology, Buchon St. Mary Hospital, The Catholic University Medical College, Buchon, Korea, Republic of
,
SH Park
3   Gastroenterology, The Catholic University of Korea, Seoul, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

It has been reported that the rate of bleeding after gastric endoscopic submucosal dissection (ESD) is 0.6 – 26.9%. Recently, as the prevalence of cardiovascular disease increases, the frequency of performing ESD is common in patients taking antiplatelet agents. We aimed to evaluate the rate of bleeding after ESD and the risk of thromboembolic events after cessation of antiplatelet agents, and to determine the optimal time of drug cessation.

Methods:

We retrospectively analyzed patients who received ESD for early gastric cancer and adenoma by using EMR databases at a single large referral hospital in Korea, between January 2010 and December 2016. We classified the patients into three groups according to the use of antiplatelet agents as follows; non-user, continuation (patients who continuously used antiplatelet or resume within 3 days) and interrupted group (patients who interrupted antiplatelet more than 3 days), and compared the rate of post-ESD bleeding and thromboembolic event. We also identified predictive factors of post-ESD bleeding by using multivariate analysis.

Results:

Of total 1379 patients, 1101 were non-users, 114 were continuation group and 164 were interrupted group. Post-ESD bleeding within 30 days occurred in 67 patients overall, where result shows statistically higher rate in the continuation group than in non-users or interrupted group (14.0 vs. 3.9 vs. 4.9%; p = 0.001). However, there were no significant differences between non-users and interrupted group. None of the patients showed thromboembolic events within 30 days. In multivariate analysis, continuous antiplatelet use was a risk factor of post-ESD bleeding (OR 3.58, 95% Cl 1.94 – 6.59). The specimen size (≥4 cm) and procedure time (≥40 min) were also independent predictors of post-ESD bleeding.

Conclusions:

Continuous use of antiplatelet agents increased the risk of bleeding after gastric ESD. Discontinuation of antiplatelet agents within 3 days is appropriate to prevent bleeding and thromboembolic-related complications.