Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
J Gastroenterol Hepatol. 2018 Feb;33(2):453-460. doi: 10.1111/jgh.13872.
The safety of gastric endoscopic submucosal dissection (ESD) in the antithrombotic drug users remains controversial.
Patients who underwent gastric ESD at Okayama University Hospital between March 2006 and February 2016 were enrolled. This study investigated the risk of post-ESD bleeding according to the management of the antithrombotic drugs.
One thousand twenty lesions (872 patients) were enrolled. In a multivariate analysis, heparin replacement (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.8-14), multiple antithrombotic drug use (OR 2.9, 95% CI 1.1-6.9), a resected specimen of ≥ 33 mm in diameter (OR 2.7, 95% CI 1.5-5.4), Helicobacter pylori negativity (OR 2.2, 95% CI 1.3-3.7), and tumors located in the lower third of the stomach (OR 1.7, 95% CI 1.0-2.9) were significant risk factors for post-ESD bleeding, while the continuation of aspirin or cilostazol was not (OR 2.6, 95% CI 0.72-7.8). The bleeding rate of the continuation group was comparable with that of the all cessation group among single antithrombotic drug users (4.5% vs 4.4%, P = 1.0); however, the rate of the continuation group was significantly higher than that of the all cessation group among multiple antithrombotic drug users (67% vs 15%, P = 0.020).
The risk of post-ESD bleeding differed according to the management of the antithrombotic drugs. The gastric ESD under the cessation or continuation of aspirin or cilostazol monotherapy was acceptable. However, multiple antithrombotic drug use or heparin replacement was associated with a higher risk of post-ESD bleeding.
抗血栓药物使用者行胃内镜黏膜下剥离术（ESD）的安全性仍存在争议。
本研究纳入了 2006 年 3 月至 2016 年 2 月期间在冈山大学医院行胃 ESD 的患者。研究根据抗血栓药物的管理情况，调查了 ESD 后出血的风险。
共纳入 1020 处病变（872 例患者）。多变量分析显示，肝素替代治疗（比值比 [OR] 5.0，95%置信区间 [CI] 1.8-14）、多种抗血栓药物使用（OR 2.9，95%CI 1.1-6.9）、切除标本直径≥33mm（OR 2.7，95%CI 1.5-5.4）、幽门螺杆菌阴性（OR 2.2，95%CI 1.3-3.7）和肿瘤位于胃下部（OR 1.7，95%CI 1.0-2.9）是 ESD 后出血的显著危险因素，而继续使用阿司匹林或西洛他唑则不是（OR 2.6，95%CI 0.72-7.8）。在单一抗血栓药物使用者中，继续组的出血率与全部停药组相当（4.5% vs 4.4%，P=1.0）；然而，在多种抗血栓药物使用者中，继续组的出血率显著高于全部停药组（67% vs 15%，P=0.020）。
ESD 后出血的风险因抗血栓药物的管理而异。阿司匹林或西洛他唑单药治疗的 ESD 可在停药或继续用药的情况下进行。然而，多种抗血栓药物使用或肝素替代治疗与 ESD 后出血风险增加相关。
