Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions
Abstract Background Bleeding after endoscopic submucosal dissection (ESD) in antithrombotic drug users is still one of the important issues to be solved. We performed scheduled second-look endoscopy (SLE) 5 days after ESD, when the resumption of antithrombotic agents is assumed to have achieved a st...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12876-018-0774-2 |
| _version_ | 1818026511768223744 |
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| author | Koichi Izumikawa Masaya Iwamuro Tomoki Inaba Shigenao Ishikawa Kenji Kuwaki Ichiro Sakakihara Kumiko Yamamoto Sakuma Takahashi Shigetomi Tanaka Masaki Wato Hiroyuki Okada |
| author_facet | Koichi Izumikawa Masaya Iwamuro Tomoki Inaba Shigenao Ishikawa Kenji Kuwaki Ichiro Sakakihara Kumiko Yamamoto Sakuma Takahashi Shigetomi Tanaka Masaki Wato Hiroyuki Okada |
| author_sort | Koichi Izumikawa |
| collection | DOAJ |
| description | Abstract Background Bleeding after endoscopic submucosal dissection (ESD) in antithrombotic drug users is still one of the important issues to be solved. We performed scheduled second-look endoscopy (SLE) 5 days after ESD, when the resumption of antithrombotic agents is assumed to have achieved a steady state, rather than on the day after ESD. We investigated bleeding incidence and the status of ulcers. Methods A total of 299 lesions in 299 patients subjected to ESD for gastric neoplasms were enrolled. A double dose of proton pump inhibitors was administered after ESD. SLE was planned 5 days after ESD. Post-ESD bleeding occurring before SLE was defined as early phase post-ESD bleeding, whereas bleeding after SLE was defined as later phase post-ESD bleeding. Forrest IIa and IIb ulcers are defined as high-risk ulcers requiring prophylactic hemostasis. We investigated risk factors for post-ESD bleeding, particularly focusing on the use of antithrombotic agents and the presence of high-risk ulcers requiring prophylactic hemostasis during SLE. Results Under a double dose of proton pump inhibitors, early phase post-ESD bleeding occurred in 2.3% of non-users (5/218) and 6.2% of users of antithrombotic agents (5/81). High-risk ulcers were found in 19.0% of the cases during scheduled SLE (55/289). Later phase bleeding occurred in 5.5% of cases [2.8% of non-users (6/213) and 13.2% of users of antithrombotic agents (10/76)]. Cox regression analysis revealed that the risk factor for post-ESD bleeding was antithrombotic treatment (HR: 3.56; 95% CI: 1.63–8.02, p = 0.002) alone. Among patients with high-risk ulcers, a statistically significant increase in bleeding was observed in the later phase in patients under antithrombotic therapy, compared to those not receiving any antithrombotic agents (p = 0.001). Conclusions Antithrombotic treatment is a risk factor for post-ESD bleeding despite SLE being scheduled 5 days after ESD. Later phase post-ESD bleeding was observed in 13.2% of the patients under antithrombotic treatment even after prophylactic hemostasis for high-risk ulcers. Trial registration This study was registered in the UMIN Clinical Trials Registry System (000023306). Retrospectively registered on 23rd July 2016. |
| first_indexed | 2024-12-10T04:33:10Z |
| format | Article |
| id | doaj.art-8590883a87814c8998a418fcc6e5e428 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-10T04:33:10Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
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| series | BMC Gastroenterology |
| spelling | doaj.art-8590883a87814c8998a418fcc6e5e4282022-12-22T02:02:05ZengBMCBMC Gastroenterology1471-230X2018-04-0118111010.1186/s12876-018-0774-2Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesionsKoichi Izumikawa0Masaya Iwamuro1Tomoki Inaba2Shigenao Ishikawa3Kenji Kuwaki4Ichiro Sakakihara5Kumiko Yamamoto6Sakuma Takahashi7Shigetomi Tanaka8Masaki Wato9Hiroyuki Okada10Department of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Internal Medicine, Fukuyama City HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology, Kagawa Prefectural Central HospitalDepartment of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAbstract Background Bleeding after endoscopic submucosal dissection (ESD) in antithrombotic drug users is still one of the important issues to be solved. We performed scheduled second-look endoscopy (SLE) 5 days after ESD, when the resumption of antithrombotic agents is assumed to have achieved a steady state, rather than on the day after ESD. We investigated bleeding incidence and the status of ulcers. Methods A total of 299 lesions in 299 patients subjected to ESD for gastric neoplasms were enrolled. A double dose of proton pump inhibitors was administered after ESD. SLE was planned 5 days after ESD. Post-ESD bleeding occurring before SLE was defined as early phase post-ESD bleeding, whereas bleeding after SLE was defined as later phase post-ESD bleeding. Forrest IIa and IIb ulcers are defined as high-risk ulcers requiring prophylactic hemostasis. We investigated risk factors for post-ESD bleeding, particularly focusing on the use of antithrombotic agents and the presence of high-risk ulcers requiring prophylactic hemostasis during SLE. Results Under a double dose of proton pump inhibitors, early phase post-ESD bleeding occurred in 2.3% of non-users (5/218) and 6.2% of users of antithrombotic agents (5/81). High-risk ulcers were found in 19.0% of the cases during scheduled SLE (55/289). Later phase bleeding occurred in 5.5% of cases [2.8% of non-users (6/213) and 13.2% of users of antithrombotic agents (10/76)]. Cox regression analysis revealed that the risk factor for post-ESD bleeding was antithrombotic treatment (HR: 3.56; 95% CI: 1.63–8.02, p = 0.002) alone. Among patients with high-risk ulcers, a statistically significant increase in bleeding was observed in the later phase in patients under antithrombotic therapy, compared to those not receiving any antithrombotic agents (p = 0.001). Conclusions Antithrombotic treatment is a risk factor for post-ESD bleeding despite SLE being scheduled 5 days after ESD. Later phase post-ESD bleeding was observed in 13.2% of the patients under antithrombotic treatment even after prophylactic hemostasis for high-risk ulcers. Trial registration This study was registered in the UMIN Clinical Trials Registry System (000023306). Retrospectively registered on 23rd July 2016.http://link.springer.com/article/10.1186/s12876-018-0774-2Antithrombotic treatmentGastric neoplasmsGastric ulcerSecond-look endoscopyProphylactic hemostasis |
| spellingShingle | Koichi Izumikawa Masaya Iwamuro Tomoki Inaba Shigenao Ishikawa Kenji Kuwaki Ichiro Sakakihara Kumiko Yamamoto Sakuma Takahashi Shigetomi Tanaka Masaki Wato Hiroyuki Okada Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions BMC Gastroenterology Antithrombotic treatment Gastric neoplasms Gastric ulcer Second-look endoscopy Prophylactic hemostasis |
| title | Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions |
| title_full | Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions |
| title_fullStr | Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions |
| title_full_unstemmed | Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions |
| title_short | Bleeding in patients who underwent scheduled second-look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions |
| title_sort | bleeding in patients who underwent scheduled second look endoscopy 5 days after endoscopic submucosal dissection for gastric lesions |
| topic | Antithrombotic treatment Gastric neoplasms Gastric ulcer Second-look endoscopy Prophylactic hemostasis |
| url | http://link.springer.com/article/10.1186/s12876-018-0774-2 |
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