Low incidence of deep vein thrombosis after double-balloon endoscopy and colorectal submucosal dissection: Multicenter, prospective study

Abstract

Background and study aims Although deep vein thrombosis (DVT) and pulmonary embolism (PE) are major postoperative complications, risk of DVT/PE after endoscopic procedures remains unknown. This study aimed to identify risks of DVT/PE after colorectal endoscopic submucosal dissection (ESD) and double-balloon endoscopy (DBE).

Patients and methods Patients who were scheduled to undergo DBE and colorectal ESD were prospectively enrolled in this study. Before enrollment, all patients were confirmed to have no DVT on whole-leg ultrasonography (US) or contrast-enhanced computed tomography (CECT). All patients routinely underwent whole-leg US after ESD or DBE. The primary endpoint was incidence of DVT after colorectal ESD and DBE. The preplanned sample size was 170 patients in the colorectal ESD group and 75 in the DBE group.

Results Between September 2020 and June 2022, 170 patients who had colorectal ESD and 75 who had DBE were recruited for this study; however, 238 patients (ESD, n = 167; DBE, n = 71) were analyzed. Of these 238 patients, DVT occurred in only one patient after colorectal ESD and incidence of DVT was 0.4% (95% confidence interval [CI] 0–1.2) in total, including 0.6% (95% CI 0–1.8) after colorectal ESD and 0% after DBE. Conversely, no PE occurred in the entire cohort.

Conclusions This prospective study demonstrated that risk of DVT/PE following highly invasive endoscopic procedures including colorectal ESD and DBE is very low.

Keywords

Endoscopy Small Bowel - Endoscopy Lower GI Tract - Quality and logistical aspects - Performance and complications - Endoscopic resection (polypectomy, ESD, EMRc, ...)

Publikationsverlauf

Eingereicht: 17. März 2024

Angenommen nach Revision: 28. Oktober 2024

Accepted Manuscript online:
04. November 2024

Artikel online veröffentlicht:
28. November 2024

• References

• 1 Sachdeva A, Dalton M, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2018; 11: CD001484
• 2 Wells PS, Anderson DR, Rodger M. et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349: 1227-1235
• 3 Falck-Ytter Y, Francis CW, Johanson NA. et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e278S-e325S
• 4 Gould MK, Garcia DA, Wren SM. et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e227S-e277S
• 5 Kahn SR, Lim W, Dunn AS. et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e195S-e226S
• 6 Barbar S, Noventa F, Rossetto V. et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: The Padua prediction score. J Thromb Haemost 2010; 8: 2450-2457
• 7 Cronin M, Dengler N, Krauss ES. et al. Completion of the updated Caprini risk assessment model (2013 version). Clin Appl Thromb Hemost 2019; 25: 1076029619838052
• 8 Stroud W, Whitworth JM, Miklic M. et al. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol 2014; 134: 160-163
• 9 Akahoshi K, Kubokawa M, Matsumoto M. et al. Double-balloon endoscopy in the diagnosis and management of GI tract diseases: Methodology, indications, safety, and clinical impact. World J Gastroenterol 2006; 12: 7654-7659
• 10 Fujishiro M, Yahagi N, Kakushima N. et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 2007; 5: 678-683
• 11 Saito Y, Uraoka T, Matsuda T. et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 2007; 66: 966-973
• 12 Yamamoto H, Kita H, Sunada K. et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004; 2: 1010-1016
• 13 Yamamoto H, Yano T, Ohmiya N. et al. Double-balloon endoscopy is safe and effective for the diagnosis and treatment of small-bowel disorders: prospective multicenter study carried out by expert and non-expert endoscopists in Japan. Dig Endosc 2015; 27: 331-337
• 14 Ando K, Fujiya M, Nomura Y. et al. The incidence and risk factors of venous thromboembolism in patients with inflammatory bowel disease: A prospective multicenter cohort study. Digestion 2019; 100: 229-237
• 15 Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet 2010; 375: 657-663
• 16 Kobayashi N, Takeuchi Y, Ohata K. et al. Outcomes of endoscopic submucosal dissection for colorectal neoplasms: Prospective, multicenter, cohort trial. Dig Endosc 2022; 34: 1042-1051
• 17 Ohata K, Kobayashi N, Sakai E. et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: A prospective, multicenter, cohort trial from Japan. Gastroenterology 2022; 163: 1423-1434 e1422
• 18 Nakajima T, Saito Y, Tanaka S. et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 2013; 27: 3262-3270
• 19 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-1457
• 20 Kusunoki M, Miyake K, Shindo T. et al. The incidence of deep vein thrombosis in Japanese patients undergoing endoscopic submucosal dissection. Gastrointest Endosc 2011; 74: 798-804
• 21 Schulz KF, Altman DG, Moher D. et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010; 152: 726-732
• 22 Yamashita R, Nakamura M, Okayama Y. et al. Incidence and location of perioperative deep vein thrombosis in patients with bladder cancer undergoing radical cystectomy. Int J Urol 2022; 29: 259-264
• 23 Theochari CA, Theochari NA, Mylonas KS. et al. Venous thromboembolism following major abdominal surgery for cancer: A guide for the surgical intern. Curr Pharm Des 2022; 28: 787-797
• 24 Venkatachalapathy SV, Evans G, Muller AF. Endoscopy and the risk of venous thromboembolism: A case-control study. Endosc Int Open 2014; 2: E2-E5
• 25 Osaki T, Saito H, Fukumoto Y. et al. Risk and incidence of perioperative deep vein thrombosis in patients undergoing gastric cancer surgery. Surg Today 2018; 48: 525-533
• 26 Tanizawa Y, Bando E, Kawamura T. et al. Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients. Gastric Cancer 2017; 20: 878-886
• 27 Parker C, Coupland C, Hippisley-Cox J. Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ 2010; 341: c4245
• 28 Zhou H, Hu Y, Li X. et al. Assessment of the risk of venous thromboembolism in medical inpatients using the Padua prediction score and Caprini risk assessment model. J Atheroscler Thromb 2018; 25: 1091-1104
• 29 Liu X, Liu C, Chen X. et al. Comparison between Caprini and Padua risk assessment models for hospitalized medical patients at risk for venous thromboembolism: a retrospective study. Interact Cardiovasc Thorac Surg 2016; 23: 538-543