Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane, 399-4117, Japan.
Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan.
Dig Dis Sci. 2021 May;66(5):1548-1555. doi: 10.1007/s10620-020-06393-1. Epub 2020 Jun 16.
Prospective studies on bleeding risk during/after gastrointestinal endoscopic procedures are rare.
We investigated the risk of endoscopic procedure-related bleeding in patients with biopsy and/or cold snare polypectomy (CSP) in relation to antithrombotic therapy.
This prospective, observational single-center cohort study (NCT02594813) enrolled consecutive patients who underwent diagnostic esophagogastroduodenoscopy (EGD) or colonoscopy. The primary outcome measure was delayed bleeding in patients with biopsy and/or CSP who required endoscopic treatment within 2 weeks post-procedure. The secondary outcomes were immediate bleeding and the number of hemostatic clips used during the procedure.
From November 2015 to October 2018 at our institution, 3069 (mean age, 66 years) and 37,887 (57 years) patients underwent EGD with and without antithrombotic therapy, respectively. In addition, 1116 (72 years) and 11,901 (65 years) patients had colonoscopy with and without antithrombotic therapy, respectively. In the 3069 EGD patients receiving antithrombotic therapy, no delayed bleeding occurred, whereas immediate bleeding occurred in 9 of 141 patients (6.4%) with biopsy. Of the 1116 colonoscopy patients receiving antithrombotic therapy, delayed bleeding occurred in three of 228 (1.3%) following CSP. Immediate bleeding occurred in nine of 225 (4%) following biopsy and in 32 of 228 (14%) following CSP. Multivariate analysis following univariate analysis identified chronic kidney disease and CSP as factors significantly associated with procedure-related bleeding in patients taking antithrombotic agents.
The risk of delayed bleeding in diagnostic EGD with biopsy or in colonoscopy with biopsy and/or CSP was low despite continuation of antithrombotic therapy.
关于胃肠内镜检查过程中/之后出血风险的前瞻性研究较为罕见。
我们研究了行活检和/或冷圈套息肉切除术（CSP）的患者，在接受抗血栓治疗时，内镜操作相关出血的风险。
本前瞻性、观察性单中心队列研究（NCT02594813）纳入了连续接受诊断性食管胃十二指肠镜检查（EGD）或结肠镜检查的患者。主要观察指标为在操作后 2 周内，需要内镜治疗的行活检和/或 CSP 的患者中延迟性出血。次要观察指标为即刻出血和操作中使用的止血夹数量。
2015 年 11 月至 2018 年 10 月，我院 3069 例（平均年龄 66 岁）和 37887 例（57 岁）患者分别在接受有或无抗血栓治疗的 EGD，1116 例（72 岁）和 11901 例（65 岁）患者分别在接受有或无抗血栓治疗的结肠镜检查。在 3069 例接受抗血栓治疗的 EGD 患者中，无延迟性出血，而 141 例活检患者中有 9 例（6.4%）发生即刻出血。在 1116 例接受抗血栓治疗的结肠镜检查患者中，228 例行 CSP 的患者中有 3 例（1.3%）发生延迟性出血。即刻出血发生在 225 例行活检的患者中有 9 例（4%）和 228 例行 CSP 的患者中有 32 例（14%）。多变量分析排除单变量分析中的混杂因素后，发现慢性肾脏病和 CSP 是接受抗血栓药物治疗的患者与内镜操作相关出血显著相关的因素。
尽管继续抗血栓治疗，诊断性 EGD 活检或结肠镜检查活检和/或 CSP 的患者发生延迟性出血的风险较低。
