Ueki Nobue, Futagami Seiji, Akimoto Teppei, Maruki Yuta, Yamawaki Hiroshi, Kodaka Yasuhiro, Nagoya Hiroyuki, Shindo Tomotaka, Kusunoki Masafumi, Kawagoe Tetsuro, Gudis Katya, Miyake Kazumasa, Iwakiri Katsuhiko
Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo, Japan.
Digestion. 2017;96(1):21-28. doi: 10.1159/000475924. Epub 2017 Jun 14.
Recent updated guidelines of the Japanese Society of Gastroenterology recommend the use of a single dose of antiplatelet agents in patients undergoing endoscopic submucosal dissection (ESD). However, the postoperative bleeding risk after gastric ESD associated with the continuation or interruption of antithrombotic therapy remains controversial. We aimed to evaluate whether certain factors including interrupted antithrombotic therapy could affect early and delayed post-ESD bleeding risk.
Three hundred sixty-four patients with gastric neoplasms were treated with ESD at our hospital between October 2005 and December 2012. Seventy-four patients with interrupted antithrombotic therapy were undertaken with ESD. Early and delayed postoperative bleeding patterns were estimated. Various clinical characteristics such as gender, age, tumor location, tumor size, ESD procedure time, platelet count, and comorbidity were evaluated.
There was a significant difference (p = 0.042) in the ESD procedure time between the patients with postoperative bleeding and those without it. There was no significant difference in postoperative bleeding between the patients on antithrombotic therapy and not on it. Moreover, interrupted antithrombotic therapy and platelet count were significantly (p = 0.0461 and p = 0.0059, respectively) associated with early postoperative bleeding in multivariate analysis. In addition, in univariate analysis, ESD procedure time was significantly (p = 0.041) associated with delayed postoperative bleeding.
Antithrombotic therapy and prolonged ESD procedure time were significantly associated with early and delayed postoperative bleeding, respectively.
日本胃肠病学会最近更新的指南建议，接受内镜黏膜下剥离术（ESD）的患者使用单剂量抗血小板药物。然而，胃ESD术后出血风险与抗血栓治疗的持续或中断之间的关系仍存在争议。我们旨在评估包括中断抗血栓治疗在内的某些因素是否会影响ESD术后早期和延迟出血风险。
2005年10月至2012年12月期间，我院对364例胃肿瘤患者进行了ESD治疗。74例中断抗血栓治疗的患者接受了ESD。评估术后早期和延迟出血模式。评估了各种临床特征，如性别、年龄、肿瘤位置、肿瘤大小、ESD手术时间、血小板计数和合并症。
术后出血患者与未出血患者的ESD手术时间存在显著差异（p = 0.042）。接受抗血栓治疗的患者与未接受抗血栓治疗的患者术后出血无显著差异。此外，在多因素分析中，中断抗血栓治疗和血小板计数与术后早期出血显著相关（分别为p = 0.0461和p = 0.0059）。此外，在单因素分析中，ESD手术时间与术后延迟出血显著相关（p = 0.041）。
抗血栓治疗和延长的ESD手术时间分别与术后早期和延迟出血显著相关。
