Endosc Int Open 2017; 05(09): E943-E949
DOI: 10.1055/s-0043-116381
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Is it possible to perform gastric endoscopic submucosal dissection without discontinuation of a single antiplatelet of thienopyridine derivatives?

Satoshi Ono1, Masahiro Myojo2, Hideaki Harada3, Kunihiro Tsuji4, Daisuke Murakami3, Satoshi Suehiro3, Hisashi Doyama4, Jiro Ando2, Itaru Saito1, Mitsuhiro Fujishiro1, 5, Issei Komuro2, Kazuhiko Koike1
  • 1Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
  • 2Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
  • 3Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
  • 4Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
  • 5Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Further Information

Publication History

submitted 04 March 2017

accepted after revision 14 June 2017

Publication Date:
13 September 2017 (online)

Abstract

Background and study aims Combined use of thienopyridine derivatives and other antithrombotic agents is reported to be a risk factor for postoperative bleeding after gastric endoscopic submucosal dissection (ESD). However, risk associated with a single thienopyridine derivative has not been evaluated. In this study, we aimed to evaluate bleeding risks of gastric ESD without discontinuation of a single thienopyridine derivative agent.

Patients and methods This multicenter, prospective, observational cohort study included patients who had undergone implantation of a coronary artery stent and who were taking a combination of aspirin antiplatelet therapy and a thienopyridine derivative agent. Enrolled patients discontinued aspirin and underwent gastric ESD without the discontinuation of a single thienopyridine derivative agent. The primary endpoint was the major bleeding complication rate after gastric ESD.

Results Eleven patients were enrolled in this study from April 2015 to November 2016 after written informed consent was obtained. Among them, 1 patient, who had undergone surgery for a primary cardiac tumor before ESD, was excluded from the study. Ten patients underwent gastric ESD for neoplasms. En-bloc resections were achieved in all cases without intraoperative bleeding complications. Two patients experienced postoperative bleeding although neither case required a blood transfusion (95 % CI 2.5 – 55.6 %).

Conclusion En-bloc resections were possible although the postoperative bleeding rate tended to be higher in gastric ESD without discontinuation of a single thienopyridine derivative agent. Additional preventive measures are mandatory to carry out safe gastric ESD in such settings.