Ninomiya Yuki, Oka Shiro, Tanaka Shinji, Nishiyama Soki, Tamaru Yuzuru, Asayama Naoki, Shigita Kenjiro, Hayashi Nana, Chayama Kazuaki
Department of Endoscopy, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
J Gastroenterol. 2015 Oct;50(10):1041-6. doi: 10.1007/s00535-015-1053-4. Epub 2015 Feb 15.
Although Japanese guidelines proposed by the Japan Gastroenterological Endoscopy Society for endoscopic submucosal dissection (ESD) for colorectal tumors recommend continued use of low-dose aspirin (LDA), this strategy is controversial. It was our practice to interrupt LDA therapy 5-7 days before ESD until December 2010, when we instituted the new guidelines and performed ESD without interrupting LDA therapy. The aim of the present study was to confirm the validity of the noninterrupted use of LDA inpatients undergoing ESD for colorectal tumors.
We studied 582 consecutive patients with 609 colorectal tumors who underwent ESD at Hiroshima University Hospital between January 2006 and July 2014. The patients comprised three groups: LDA-interrupted group (13 patients with 13 colorectal tumors), LDA-continued group (28 patients with 31 colorectal tumors), and no anticoagulant/antiplatelet group (541 patients with 565 colorectal tumors).
The en bloc resection rate was 100% (13/13) in the LDA-interrupted group and 90.3% (28/31) in the LDA-continued group. Incidences of poor bleeding control during the procedure and bleeding after the procedure were 7.7% (1/13) and 15.4% (2/13) of patients, respectively, in the LDA-interrupted group, and 3.2% (1/31) and 16.1% (5/31) of patients, respectively, in the LDA-continued group. No patients experienced ischemic events in the perioperative period.
Our data suggest that continued use of LDA increased the risk of bleeding after ESD for colorectal tumors compared with nonuse of anticoagulant/antiplatelets. No significant difference was seen between the LDA-continued group and the LDA-interrupted group.
尽管日本胃肠内镜学会提出的日本结直肠肿瘤内镜黏膜下剥离术（ESD）指南建议持续使用低剂量阿司匹林（LDA），但该策略存在争议。在2010年12月之前，我们的做法是在ESD术前5 - 7天中断LDA治疗，之后我们制定了新指南并在不中断LDA治疗的情况下进行ESD。本研究的目的是证实结直肠肿瘤患者在接受ESD时不中断使用LDA的有效性。
我们研究了2006年1月至2014年7月在广岛大学医院接受ESD的582例连续患者的609个结直肠肿瘤。患者分为三组：LDA中断组（13例患者的13个结直肠肿瘤）、LDA持续组（28例患者的31个结直肠肿瘤）和无抗凝/抗血小板组（541例患者的565个结直肠肿瘤）。
LDA中断组的整块切除率为100%（13/13），LDA持续组为90.3%（28/31）。LDA中断组术中出血控制不佳和术后出血的发生率分别为7.7%（1/13）和15.4%（2/13）的患者，LDA持续组分别为3.2%（1/31）和16.1%（5/31）的患者。围手术期无患者发生缺血事件。
我们的数据表明，与不使用抗凝/抗血小板药物相比，持续使用LDA增加了结直肠肿瘤ESD术后出血的风险。LDA持续组和LDA中断组之间未见显著差异。
