Center for Epidemiology and Preventive Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
J Gastroenterol. 2012 Jul;47(7):770-4. doi: 10.1007/s00535-012-0538-7. Epub 2012 Feb 18.
Although guidelines in Japan recommend the cessation of antithrombotic agents before endoscopic biopsy, the safety of biopsy without the cessation of these agents has not been evaluated to date in this country. Therefore, we aimed to assess the feasibility of biopsy without cessation of antithrombotic agents in Japan.
This was a prospective single-arm study from a single institution. From May 2010 to November 2011, 112 outpatients who were receiving antithrombotic agents because of their high-risk status for a thromboembolic event (after implantation of coronary stent, after valve replacement, or a previous history of thromboembolic event or heart failure due to atrial fibrillation) were enrolled. We evaluated the rate of severe bleeding complications within 2 weeks after endoscopy and the endoscopic bleeding time (EBT) after biopsy in patients who underwent biopsy for endoscopic findings requiring pathology assessment.
Among the 112 participants, 101 biopsies were performed for 48 and 12 outpatients who had had esophagogastroduodenoscopy and colonoscopy, respectively. All the biopsies provided enough specimens to evaluate pathologically. Hemostasis after biopsy was confirmed for all biopsies during endoscopic observation. No patients complained of any bleeding symptoms in the 2-week observation period after biopsy (0/101; 95% confidence interval [CI] 0-3.6%). Concerning the EBT (median 2.2 ± 1.8 min, range 0.5-9 min), there were no significant differences between patients receiving single antithrombotic agents and those receiving multiple agents (2.4 ± 1.4 vs. 2.1 ± 2.1 min), nor were there any significant differences between patients not receiving and receiving warfarin (2.3 ± 1.8 vs. 2.2 ± 1.8 min).
Biopsy without cessation of antithrombotic agents, as recommended in Western guidelines, can also be acceptable for Japanese people if performed carefully.
尽管日本的指南建议在内镜活检前停止使用抗血栓药物，但迄今为止，该国尚未评估这些药物不停用的情况下进行活检的安全性。因此，我们旨在评估在日本不停用抗血栓药物进行活检的可行性。
这是一项来自单一机构的前瞻性单臂研究。2010 年 5 月至 2011 年 11 月，共纳入 112 例因血栓栓塞事件高风险状态（冠状动脉支架植入后、瓣膜置换后、或既往血栓栓塞事件或心房颤动导致心力衰竭）而接受抗血栓药物治疗的门诊患者。我们评估了内镜检查后 2 周内严重出血并发症的发生率以及需要病理评估的内镜发现患者进行活检后的内镜出血时间（EBT）。
在 112 名参与者中，48 名患者接受了食管胃十二指肠镜检查，12 名患者接受了结肠镜检查，分别对其中 101 例进行了活检。所有活检均提供了足够的标本进行病理评估。在内镜观察期间，所有活检后均确认止血。在活检后的 2 周观察期内，没有患者出现任何出血症状（0/101；95%置信区间[CI]0-3.6%）。关于 EBT（中位数 2.2±1.8 分钟，范围 0.5-9 分钟），接受单一抗血栓药物和接受多种药物的患者之间（2.4±1.4 与 2.1±2.1 分钟），以及未接受和接受华法林的患者之间（2.3±1.8 与 2.2±1.8 分钟）均无显著差异。
如果谨慎操作，西方指南推荐的不停用抗血栓药物进行活检也可被日本患者接受。
