Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Gut Liver. 2022 Mar 15;16(2):198-206. doi: 10.5009/gnl210157.
BACKGROUND/AIMS: Postprocedural bleeding is known to be relatively low after argon plasma coagulation (APC) for gastric neoplasms; however, there are few studies proving the effect of antithrombotic agents. This study aimed to analyze the incidence of delayed bleeding (DB) based on antithrombotic agents administered and to identify the risk factors for DB in APC for gastric tumors.
A total of 785 patients with 824 lesions underwent APC for single gastric neoplasm between January 2011 and January 2018. After exclusion, 719 and 102 lesions were classified as belonging to the non-antithrombotics (non-AT) and AT groups, respectively. The clinical outcomes were compared between the two groups, and we determined the risk factors for DB in gastric APC.
Of the total 821 cases, DB occurred in 20 cases (2.4%): 17 cases in the non-AT group and three cases in the AT group (2.4% vs 2.9%, p=0.728). Multivariate analysis of the risk factors for DB confirmed the following significant, independent risk factors: male sex (odds ratio, 7.66; 95% confidence interval, 1.02 to 57.69; p=0.048) and chronic kidney disease (odds ratio, 4.51; 95% confidence interval, 1.57 to 13.02; p=0.005). Thromboembolic events and perforation were not observed in all patients regardless of whether they took AT agents.
AT therapy is acceptably safe in gastric APC because it does not significantly increase the incidence of DB. However, patients with chronic kidney disease or male sex need to receive careful follow-up on the incidence of post-APC bleeding.
背景/目的：氩等离子凝固（APC）治疗胃肿瘤后，已知其术后出血相对较低，但很少有研究证明抗血栓药物的疗效。本研究旨在分析基于抗血栓药物使用的延迟出血（DB）发生率，并确定 APC 治疗胃肿瘤 DB 的危险因素。
2011 年 1 月至 2018 年 1 月期间，共有 785 例 824 处胃肿瘤患者接受了 APC 治疗。排除后，719 处和 102 处病变分别归入非抗血栓组（non-AT）和抗血栓组（AT）。比较两组患者的临床结果，并确定胃 APC 中 DB 的危险因素。
821 例患者中，DB 发生 20 例（2.4%）：非 AT 组 17 例，AT 组 3 例（2.4%vs2.9%，p=0.728）。DB 的多因素分析确定以下显著的独立危险因素：男性（比值比，7.66；95%置信区间，1.02 至 57.69；p=0.048）和慢性肾脏病（比值比，4.51；95%置信区间，1.57 至 13.02；p=0.005）。所有患者均未观察到血栓栓塞事件和穿孔，无论是否使用 AT 药物。
AT 治疗在胃 APC 中是安全的，因为它不会显著增加 DB 的发生率。然而，患有慢性肾脏病或男性的患者需要密切关注 APC 后出血的发生率。
