Kono Yoshiyasu, Matsubara Minoru, Toyokawa Tatsuya, Takenaka Ryuta, Suzuki Seiyu, Nasu Junichirou, Yoshioka Masao, Nakagawa Masahiro, Mizuno Motowo, Sakae Hiroyuki, Abe Makoto, Gotoda Tatsuhiro, Miura Ko, Kanzaki Hiromitsu, Iwamuro Masaya, Hori Keisuke, Tsuzuki Takao, Kita Masahide, Kawano Seiji, Kawahara Yoshiro, Okada Hiroyuki
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Department of Internal Medicine, Sumitomo Bessi Hospital, Niihama, 792-8543, Japan.
Dig Dis Sci. 2017 Mar;62(3):730-738. doi: 10.1007/s10620-016-4437-2. Epub 2017 Jan 3.
The Japan Gastroenterological Endoscopy Society updated its guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment in July 2012. However, the safety of endoscopic procedures in antithrombotic drug users has not been fully investigated.
To evaluate the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users.
From September 2013 to September 2015, patients who were taking antithrombotic drugs and who underwent upper gastrointestinal endoscopic procedures were prospectively enrolled at five hospitals. Incidences of bleeding and thrombosis during endoscopic procedures were evaluated.
A total of 270 patients [221 for endoscopic mucosal biopsy and 49 for endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) were enrolled. The bleeding rate was 0.9% for endoscopic mucosal biopsy and 22% for EMR/ESD, respectively. The bleeding rate after endoscopic mucosal biopsy was not significantly high, even if antithrombotic drugs were continued (0 vs. 1%, P > 0.99), while it was significantly higher among multiple antithrombotic drug users than single drug users (5.9 vs. 0%, P < 0.05). The bleeding rate after EMR/ESD was also higher among multiple antithrombotic drug users than single drug users, but was not significantly different (33 vs. 14%, P = 0.17). Moreover, there were no differences in bleeding rates according to the cessation or continuance of antithrombotic drugs (20 vs. 25%, P = 0.74). There were no thromboembolisms in all cases.
Upper gastrointestinal endoscopic procedures performed under the new guidelines appear acceptable. However, endoscopic procedures among multiple antithrombotic drug users show a greater potential for bleeding.
日本胃肠内镜学会于2012年7月更新了接受抗血栓治疗患者的胃肠内镜检查指南。然而，抗血栓药物使用者内镜操作的安全性尚未得到充分研究。
评估抗血栓药物使用者上消化道内镜操作的安全性。
2013年9月至2015年9月，前瞻性纳入五家医院正在服用抗血栓药物并接受上消化道内镜操作的患者。评估内镜操作期间出血和血栓形成的发生率。
共纳入270例患者[221例行内镜黏膜活检，49例行内镜黏膜切除术（EMR）/内镜黏膜下剥离术（ESD）]。内镜黏膜活检的出血率分别为0.9%，EMR/ESD为22%。即使继续使用抗血栓药物，内镜黏膜活检后的出血率也没有显著升高（0%对1%，P>0.99），而多重抗血栓药物使用者的出血率显著高于单一药物使用者（5.9%对0%，P<0.05）。EMR/ESD后的出血率在多重抗血栓药物使用者中也高于单一药物使用者，但差异无统计学意义（33%对14%，P=0.17）。此外，根据抗血栓药物的停用或继续使用情况，出血率没有差异（20%对25%，P=0.74）。所有病例均未发生血栓栓塞。
在新指南下进行的上消化道内镜操作似乎是可以接受的。然而，多重抗血栓药物使用者的内镜操作出血风险更大。
