Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 10, 2016; 8(7): 349-356
Published online Apr 10, 2016. doi: 10.4253/wjge.v8.i7.349
Risk factors for postoperative bleeding after gastric endoscopic submucosal dissection in patients under antithrombotics
Yuji Shindo, Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Hirosato Mashima
Yuji Shindo, Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Hirosato Mashima, Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan
Author contributions: Shindo Y collected and analyzed the data, and drafted the manuscript; Matsumoto S provided analytical oversight and designed and supervised the study; Miyatani H, Yoshida Y and Mashima H revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.
Institutional review board statement: The study design was reviewed and approved by the Ethics Committee of Jichi Medical University, Saitama Medical Center (Approval No. RIN14-07).
Informed consent statement: This study was a retrospective patient’s medical records review using a de-identified patient database.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yuji Shindo, MD, Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma, Omiya, Saitama 330-8503, Japan. yujimax7777@jichi.ac.jp
Telephone: +81-48-6472111 Fax: +81-48-6485188
Received: October 29, 2015
Peer-review started: October 30, 2015
First decision: December 11, 2015
Revised: December 27, 2015
Accepted: January 29, 2016
Article in press: January 31, 2016
Published online: April 10, 2016
Processing time: 158 Days and 14.7 Hours
Abstract

AIM: To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection (ESD) based on the latest guidelines.

METHODS: A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for post-ESD bleeding.

RESULTS: Of the 48 (18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases. Postoperative bleeding occurred in 23 cases (8.8%). The postoperative bleeding rate in the heparin replacement group was 61.5%, significantly higher than that in the non-antithrombotic therapy group (6.1%). Univariate analysis identified history of antithrombotic drug use, heparin replacement, hemodialysis, cardiovascular disease, diabetes mellitus, elevated prothrombin time-international normalized ratio, and low hemoglobin level on admission as risk factors for post ESD bleeding. Multivariate analysis identified only heparin replacement (OR = 13.7, 95%CI: 1.2-151.3, P = 0.0329) as a significant risk factor for post-ESD bleeding.

CONCLUSION: Continued administration of antiplatelet agents, based on the guidelines, was not a risk factor for postoperative bleeding after gastric ESD; however, heparin replacement, which is recommended after withdrawal of oral anticoagulants, was identified as a significant risk factor.

Keywords: Postoperative bleeding; Antithrombotic treatment; Gastric neoplasms; Endoscopic submucosal dissection

Core tip: There are few data on the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection (ESD) in patients continued on antithrombotic treatment during the perioperative period. This study was aimed to evaluate the risk factors for postoperative bleeding after gastric ESD in patients continued or not continued on antithrombotic treatment. Univariate analysis showed that an antithrombotic agent user, especially heparin replacement was significantly associated with risk factors for postoperative bleeding. Multivariate analysis identified heparin replacement as the independent risk factor for post ESD bleeding. Therefore, patients with heparin replacement should be carefully observed after gastric ESD.