Effects of antithrombotic therapy on bleeding after endoscopic submucosal dissection

Dong, Jiaqi; Wei, Kunyan; Deng, Jiaqi; Zhou, Xi; Huang, Xiao Li; Deng, Mingming; Lü, Muhan

doi:10.1016/j.gie.2017.07.017

Cited by 45 publications

(73 citation statements)

References 39 publications

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“…Japanese Gastroenterological Endoscopy Society (JGES) guidelines, however, recommend carrying out high‐bleeding‐risk procedure without interruption of low‐dose aspirin (LDA) therapy in patients who are at high risk for thromboembolic events . Several comparative studies showed a delayed bleeding rate in patients who underwent gastric ESD under continuation of LDA ranging from 3.6% to 21.1%, whereas that in those who interrupted LDA was similar (3.6%–23.8%) (Table ) . Two meta‐analyses of observational studies indicated similar delayed bleeding rate after gastric ESD between continuation and interruption of LDA .…”

Section: Adverse Events Related To Gastric Esdmentioning

confidence: 99%

“…Because of the high delayed bleeding rates after gastric ESD in patients taking multiple antithrombotics including anticoagulants, ranging from 11.1% to 45.4% (Table ), use of multiple antithrombotic drugs is one of the high risk factors. A meta‐analysis indicated that the risk of delayed bleeding after gastric ESD in regular users of multiple antithrombotic drugs was significantly higher than never users (odds ratio 5.17 [95% CI: 3.13–8.54]) …”

Section: Adverse Events Related To Gastric Esdmentioning

confidence: 99%

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Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Yamamoto

Kikuchi

Nagami

et al. 2019

Digestive Endoscopy

101

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Prevention therapy is recommended for lesions >1/2 of the esophageal circumference. Locoregional steroid injection is recommended for lesions >1/2–3/4 of the esophageal circumference and oral steroids are recommended for lesions >1/2 of the subtotal circumference. For lesions of the entire circumference, oral steroid combined with injection steroid is considered. Endoscopic balloon dilatation (EBD) is the first choice of treatment for stricture after esophageal endoscopic submucosal dissection (ESD). Radical incision and cutting or self‐expandable metallic stent can be considered for refractory stricture after EBD. In case of intraoperative perforation during esophageal ESD, endoscopic clip closure should be initially attempted. Surgery is considered for treatment of delayed perforation. Current standard practice for prevention of delayed bleeding after gastric ESD includes prophylactic coagulation of vessels on post‐ESD ulcers and giving proton pump inhibitors. Chronic kidney disease stage 4 or 5, multiple antithrombotic drug use, anticoagulant use, and heparin bridging therapy are high‐risk factors for delayed bleeding after gastric ESD. Intraoperative perforation during gastric ESD is initially managed by endoscopic clip closure. If endoscopic clip closure is difficult, other methods such as over‐the‐scope clip (OTSC), polyglycolic acid (PGA) sheet shielding etc. are attempted. Delayed perforation usually requires surgical intervention, but endoscopic closure by OTSC or PGA sheet may be considered. Resection of three‐quarters of the circumference is a risk factor for stenosis after gastric ESD. Giving prophylactic local steroid injection and/or oral steroid is reported, but effectiveness has not been fully verified as has been done for esophageal stricture. The main management method for gastric stenosis is EBD but it may cause perforation.

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Section: Adverse Events Related To Gastric Esdmentioning

confidence: 99%

Section: Adverse Events Related To Gastric Esdmentioning

confidence: 99%

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Yamamoto

Kikuchi

Nagami

et al. 2019

Digestive Endoscopy

101

View full text Add to dashboard Cite

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“…For antiplatelet drugs, some studies have shown that the continuous or discontinued use of aspirin does not increase the incidence of postoperative bleeding in patients undergoing ESD . Therefore, guidelines recommend continuous aspirin use during gastric ESD to reduce the incidence of thrombotic events .…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

“…However, Nam et al's study showed that clopidogrel could significantly increase the risks of both early (with 24 h after ESD) and delayed post‐ESD bleeding. The guidelines also recommend that clopidogrel should be discontinued or switched to aspirin during gastric ESD . Currently, there is insufficient data on the use of other antiplatelet drug.…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

“…However, subsequent studies indicated that patients on heparin replacement therapy had a higher incidence of delayed hemorrhage than those continuing warfarin . When analyzing the risks of hemorrhage during heparin replacement therapy, Dong et al performed a meta‐analysis that included 10 540 patients from 16 studies, showing that heparin replacement therapy could increase the incidence of post‐ESD bleeding. Therefore, in 2017 guidelines the Japan Gastroenterological Endoscopy Society no longer recommend heparin replacement therapy for patients undergoing endoscopic surgery with anticoagulants …”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

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Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

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Endoscopic submucosal dissection (ESD) is generally used to treat gastric mucosal and submucosal lesions. Nevertheless, ESD is more difficult and complicated to perform than a traditional endoscopic mucosal resection, which can increase the incidence of various complications including hemorrhage, perforation and infection. Hemorrhage is a major post‐ESD complication. Prevention and early diagnosis of post‐ESD bleeding for gastric lesions are closely associated with the efficacy and safety of the operation. Many studies have reported the risks of and the preventative measures for hemorrhage after gastric ESD, but there remain some issues to be solved. We thus reviewed the risk factors, precautions and treatments for hemorrhage after ESD of gastric lesions.

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Spray coagulation reduces the use of hemostatic forceps for intraoperative bleeding in gastric endoscopic submucosal dissection

Ishikawa,

Goto,

Nakagome

et al. 2024

JGH Open

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AimsDuring intraoperative bleeding in endoscopic submucosal dissection (ESD), switching to spray coagulation may be beneficial compared with the continuous use of swift coagulation and can reduce the need for hemostatic forceps. We retrospectively assessed the effectiveness of spray modes on intraoperative bleeding during gastric ESD.Methods and ResultsA total of 316 bleeding events (156 in the Swift group and 160 in the Spray group) were consecutively recorded. In the Swift group, hemostasis was performed using the swift mode with a retracted tip of the needle‐type knife, followed by the hemostatic forceps. In the Spray group, bleeding was treated in a stepwise manner: the swift mode, the spray mode, and the hemostatic forceps. All bleeding events were assigned to one of two groups by an endoscopist who retrospectively reviewed the videos. We compared the use of hemostatic forceps, the total hemostatic time, and the cumulative hemostasis rate between the two groups.The use of hemostatic forceps was significantly lower in the Spray group than in the Swift group (32.7% vs. 13.8%, P < 0.001). There was no significant difference in the total hemostatic time (Swift group, 20 s.; Spray group, 16 s.; P = 0.42), whereas the cumulative hemostasis rate with the knife was significantly higher in the Spray group (P = 0.007).ConclusionThe results suggested that spray coagulation from the tip of the needle‐type knife could reduce the use of hemostatic forceps. In gastric ESD, spray coagulation may facilitate the hemostasis of intraoperative bleeding.

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Effects of antithrombotic therapy on bleeding after endoscopic submucosal dissection

Cited by 45 publications

References 39 publications

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Bleeding after endoscopic submucosal dissection of gastric lesions

Spray coagulation reduces the use of hemostatic forceps for intraoperative bleeding in gastric endoscopic submucosal dissection

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