MD, MSc. General Surgeon, Gastrointestinal Surgeon and Molecular Oncology Doctoral Student, University of Health Sciences, Haseki Research and Education Hospital, Istanbul, Turkey.
MD, MSc. General Surgeon, Gastrointestinal Surgeon and Molecular Oncology Doctoral Student, University of Health Sciences, Haydarpaşa Research and Education Hospital, Istanbul, Turkey.
Sao Paulo Med J. 2021 Mar 22;139(3):218-225. doi: 10.1590/1516-3180.2020.0305.R1.10122020. eCollection 2021.
In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding.
The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy.
Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey.
Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded.
The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05).
This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.
2012 年 7 月，日本胃肠内镜学会更新了接受抗血栓治疗患者胃肠内镜检查指南。结肠镜息肉切除术与出血风险较高相关。
本研究评估了接受抗血栓治疗的患者行结肠镜息肉切除术时出血的安全性。
在土耳其伊斯坦布尔的一家三级公立心血管医院的内镜中心进行前瞻性观察性研究。
前瞻性评估 2018 年 7 月至 2019 年 7 月在单一内镜中心进行的结肠镜息肉切除术。记录患者数据，包括年龄、性别、合并症、是否停止使用抗血栓药物以及是否改用桥接治疗、息肉大小、息肉类型、息肉位置、组织病理学、切除方法（热圈套、冷圈套或活检钳）以及与操作相关的并发症。
共有 94 例患者完成了研究，共进行了 167 次息肉切除术。根据开具抗血栓药物的医生的建议，60 例患者中有 108 例未停药进行息肉切除术，34 例患者停药后进行 59 例息肉切除术。停药和未停药患者的年龄、性别分布和出血率无显著差异（P>0.05）。
本研究发现，不停用抗血栓药物的结肠镜息肉切除术不会增加出血风险。在国际标准化比值（INR）低于 2.5 的情况下，经验丰富的内镜医生可以安全地进行该手术。
