Kobayashi Yoshiya, Komazawa Yoshinori, Yuki Mika, Ishitobi Hitomi, Nagaoka Makoto, Takahashi Yoshiko, Nakashima Sayaka, Shizuku Toshihiro, Kinoshita Yoshikazu
Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan.
Department of Gastroenterology and Hepatology, Shimane University, Shimane, Japan.
Endosc Int Open. 2018 Jan;6(1):E104-E110. doi: 10.1055/s-0043-124366. Epub 2018 Jan 16.
Unsedated transnasal endoscopy (uTNE) has become accepted as a safe and tolerable method for upper gastrointestinal tact examinations. Epistaxis is 1 of the major complications of TNE, though its risk factors have not been elucidated. Generally, patients administered an anticoagulant or antiplatelet drug are considered to have an increased risk of epistaxis during TNE. Here, we investigated risk factors of epistaxis in patients undergoing uTNE, with focus on those who received antithrombotic agents.
We enrolled 6860 patients (average age 55.6 ± 12.97 years; 3405 males, 3455 females) who underwent uTNE and received the same preparations for the procedure. Epistaxis was evaluated using endoscopic images obtained while withdrawing the scope through the nostril. We also noted current use of medications including anticoagulant or antiplatelet agents prior to the endoscopic examination.
Epistaxis occurred in 3.6 % of the enrolled patients (245/6860), and that rate was significantly higher in younger patients (average age 49.31 ± 11.8 years for epistaxis group vs. 55.83 ± 13.0 years for no epistaxis group, < 0.01) as well as females (4.78 % vs. 2.35 %, < 0.01). The odds ratio for occurrence of epistaxis was 2.31 (95 %CI: 1.746 - 3.167) in the younger patients and 2.02 (95 % CI: 1.542 - 2.659) in females. In contrast, there was no significant difference for rate of epistaxis between patients with and without treatment with an antithrombotic agent (3.0 % vs. 3.6 %).
The rate of epistaxis was higher in younger and female patients. Importantly, that rate was not significantly increased in patients who were administered an antithrombotic agent.
非镇静经鼻内镜检查（uTNE）已被公认为是一种安全且耐受性良好的上消化道检查方法。鼻出血是经鼻内镜检查的主要并发症之一，但其危险因素尚未阐明。一般认为，接受抗凝药或抗血小板药物治疗的患者在经鼻内镜检查期间鼻出血风险增加。在此，我们研究了接受uTNE患者鼻出血的危险因素，重点关注那些接受抗血栓药物治疗的患者。
我们纳入了6860例接受uTNE且检查前接受相同准备的患者（平均年龄55.6±12.97岁；男性3405例，女性3455例）。通过在经鼻孔退出内镜时获取的内镜图像评估鼻出血情况。我们还记录了内镜检查前当前使用的药物，包括抗凝药或抗血小板药物。
纳入患者中3.6%（245/6860）发生鼻出血，该发生率在年轻患者中显著更高（鼻出血组平均年龄49.31±11.8岁，无鼻出血组平均年龄55.83±13.0岁，P<0.01），在女性中也显著更高（4.78%对2.35%，P<0.01）。年轻患者鼻出血的比值比为2.31（95%CI：1.746 - 3.167），女性为2.02（95%CI：1.542 - 2.659）。相比之下，接受和未接受抗血栓药物治疗的患者鼻出血发生率无显著差异（3.0%对3.6%）。
年轻患者和女性患者鼻出血发生率更高。重要的是，接受抗血栓药物治疗的患者鼻出血发生率并未显著增加。
