scholarly journals Does second-look endoscopy reduce the bleeding after gastric endoscopic submucosal dissection for patients receiving antithrombotic therapy?

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takeshi Uozumi ◽  
Tetsuya Sumiyoshi ◽  
Yusuke Tomita ◽  
Kaho Tokuchi ◽  
Hiroya Sakano ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Antithrombotic Therapy ◽  
Average Risk ◽  
Antithrombotic Agents ◽  
Risk Of Bleeding ◽  
Submucosal Dissection ◽  
Second Look ◽  
Epithelial Neoplasms ◽  
Multiple Therapy

Abstract Background In patients with average risk of bleeding, second-look endoscopy does not reportedly reduce bleeding after gastric endoscopic submucosal dissection. However, effectiveness of second-look endoscopy for patients with a high risk of bleeding, such as those who are taking antithrombotic agents, is unclear. Hence, this study aims to clarify the effectiveness of second-look endoscopy for patients with antithrombotic therapy. Methods We studied 142 consecutive patients with 173 gastric epithelial neoplasms who were routinely taking antithrombotic agents and were treated by endoscopic submucosal dissection at Tonan Hospital between November 2013 and December 2019. They were classified into two groups: those with second-look endoscopy (SLE group, 69 patients with 85 lesions) and those without second-look endoscopy (non-SLE group, 73 patients with 88 lesions). The incidence of post-endoscopic submucosal dissection bleeding was compared between the SLE and non-SLE groups. Results There were no statistical differences in the rate of patients undergoing single antiplatelet therapy, single anticoagulant therapy, and multiple therapy between the SLE and non-SLE groups (SLE group vs. non-SLE group; 32 [46.4%], 16 [23.2%], and 21 [30.4%] patients vs. 37 [50.7%], 20 [27.4%], and 16 [21.9%] patients, respectively; p = 0.50). Post-endoscopic submucosal dissection bleeding incidence was 21.7% (15/69) and 21.9% (16/73) in the SLE and non-SLE groups, respectively, and did not significantly differ between the two groups (p = 0.98). Conclusions For patients taking antithrombotic agents, the incidence of post-endoscopic submucosal dissection bleeding was not reduced by second-look endoscopy.

scholarly journals Does second-look endoscopy reduce the bleeding after gastric endoscopic submucosal dissection for patients receiving antithrombotic therapy?

2020 ◽  
Author(s):  
Takeshi Uozumi ◽  
Tetsuya Sumiyoshi ◽  
Yusuke Tomita ◽  
Kaho Tokuchi ◽  
Hiroya Sakano ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Antithrombotic Therapy ◽  
Average Risk ◽  
Antithrombotic Agents ◽  
Risk Of Bleeding ◽  
Submucosal Dissection ◽  
Second Look ◽  
Epithelial Neoplasms ◽  
Multiple Therapy

Abstract Background: In patients with average risk of bleeding, second-look endoscopy does not reportedly reduce bleeding after gastric endoscopic submucosal dissection. However, effectiveness of second-look endoscopy for patients with high risk of bleeding such as those who are taking antithrombotic agents remains controversial. Hence, this study aims to clarify the effectiveness of second-look endoscopy for patients with antithrombotic therapy.Methods: We studied 142 consecutive patients with 173 gastric epithelial neoplasms who were routinely taking antithrombotic agents and were treated by endoscopic submucosal dissection at Tonan Hospital between November 2013 and December 2019. They were classified into two groups: those with second-look endoscopy (SLE group, 69 patients with 85 lesions) and those without second-look endoscopy (non-SLE group, 73 patients with 88 lesions). The incidence of post-endoscopic submucosal dissection bleeding was compared between the SLE and non-SLE groups.Results: There were no statistical differences in the rate of patients undergoing single antiplatelet therapy, single anticoagulant therapy, and multiple therapy between the SLE and non-SLE groups (SLE group vs. non-SLE group; 32 [46.4%], 16 [23.2%], and 21 [30.4%] patients vs. 37 [50.7%], 20 [27.4%], and 16 [21.9%] patients, respectively; p = 0.50). Post-endoscopic submucosal dissection bleeding incidence was 21.7% (15/69) and 21.9% (16/73) in the SLE and non-SLE groups, respectively, and did not significantly differ between the two groups (p = 0.98).Conclusions: For patients taking antithrombotic agents, the incidence of post-endoscopic submucosal dissection bleeding was not reduced by second-look endoscopy.

scholarly journals Feasibility of a modified search, coagulation, and clipping method with and without the use of polyglycolic acid sheets and fibrin glue for preventing delayed bleeding after gastric endoscopic submucosal dissection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Satoshi Abiko ◽  
Soichiro Oda ◽  
Akimitsu Meno ◽  
Akane Shido ◽  
Sonoe Yoshida ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Median Time ◽  
Fibrin Glue ◽  
Polyglycolic Acid ◽  
Low Risk ◽  
R0 Resection ◽  
Antithrombotic Agents ◽  
Delayed Bleeding ◽  
Submucosal Dissection

Abstract Background Methods have been developed for preventing delayed bleeding (DB) after gastric endoscopic submucosal dissection (GESD). However, none of the methods can completely prevent DB. We hypothesized that DB could be prevented by a modified search, coagulation, and clipping (MSCC) method for patients at low risk for DB and by combining the use of polyglycolic acid sheets and fibrin glue with the MSCC method (PMSCC method) for patients at high risk for DB (antibleeding [ABI] strategy). This study assessed the technical feasibility of this novel strategy. Method We investigated 123 lesions in 121 consecutive patients who underwent GESD in Kushiro Rosai Hospital between April 2018 and January 2020. The decision for continuation or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment. Results Oral antithrombotic agents were administered to 28 patients (22.8%). The en bloc R0 resection rate was 98.4%. The MSCC method and the PMSCC method for preventing DB were performed in 114 and 9 lesions, respectively. The median time of the MSCC method was 16 min, and the median speed (the resection area divided by the time of method used) was 3.6 cm2/10 min. The median time of the PMSCC method was 59 min, and the median speed was 1.3 cm2/10 min. The only delayed procedural adverse event was DB in 1 (0.8%) of the 123 lesions. Conclusions The ABI strategy is feasible for preventing DB both in patients at low risk and in those at high risk for DB after GESD, whereas the PMSCC method may be necessary for reduction of time.

scholarly journals Feasibility of a modified search, coagulation, and clipping method with and without the use of polyglycolic acid sheets and fibrin glue for preventing delayed bleeding after gastric endoscopic submucosal dissection

2020 ◽  
Author(s):  
Satoshi Abiko ◽  
Soichiro Oda ◽  
Akimitsu Meno ◽  
Akane Shido ◽  
Sonoe Yoshida ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Fibrin Glue ◽  
Polyglycolic Acid ◽  
Low Risk ◽  
R0 Resection ◽  
Antithrombotic Agents ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection

Abstract Background: Methods have been developed for preventing delayed bleeding (DB) after gastric endoscopic submucosal dissection (GESD). However, none of the methods can completely prevent DB. We hypothesized that DB could be prevented by a modified search, coagulation, and clipping (MSCC) method for patients at low risk for DB and by combining the use of polyglycolic acid (PGA) sheets and fibrin glue with the MSCC method (PMSCC method) for patients at high risk for DB (antibleeding [ABI] strategy). This study assessed the technical feasibility of this novel strategy.Methods: We investigated 123 lesions in 121 consecutive patients who underwent GESD in Kushiro Rosai Hospital between April 2018 and January 2020. The decision for continuation or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment.Results: Oral antithrombotic agents were administered to 28 patients (22.8%). The en bloc R0 resection rate was 98.4%. The MSCC method and the PMSCC method for preventing DB were performed in 114 and 9 lesions, respectively. The median resection time of the MSCC method was 16 min, and the median speed (the resection area divided by the resection time) was 3.6 cm2/10 min. The median resection time of the PMSCC method was 59 min, and the median speed was 1.3 cm2/10 min. The only delayed procedural adverse event was DB in 1 (0.8%) of the 123 lesions.Conclusions: The ABI strategy is feasible for preventing DB both in patients at low risk and in those at high risk for DB after GESD, whereas the PMSCC method may be necessary for reduction of time.

scholarly journals Strategies that Reduce Post-endoscopic Submucosal Dissection Bleeding

2021 ◽  
Vol 21 (3) ◽  
pp. 194-202
Author(s):  
Da Hyun Jung ◽  
Jun Chul Park
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Hospital Costs ◽  
Antithrombotic Agents ◽  
Readmission Rates ◽  
Submucosal Dissection ◽  
Number Of Patients ◽  
Risk Patients ◽  
Prevention Methods

Bleeding after endoscopic submucosal dissection (ESD), one of the most common postprocedural adverse events, is the main cause of increased readmission rates and hospital costs. Generally, the incidence of post-ESD bleeding is estimated to be about 5%. However, the incidence of bleeding is particularly increased in high-risk patients. In particular, it has an incidence of over 50% in patients that use antithrombotic agents. The well-known risk factors for post-ESD bleeding include antithrombotic therapy, lesions in the proximal stomach, specimen size >4 cm, and concomitant renal disease. Currently, the number of patients at a high risk of post-ESD bleeding has been increasing. This may be due to the aging society and the increase in the usage of antithrombotic agents. Therefore, several strategies have been employed to prevent post-ESD bleeding. These strategies include acid inhibition therapy, preventive hemostasis using Doppler endoscopic ultrasound and artery-selective clipping, second look endoscopy, the closings method, and the shield methods. However, these methods are technically demanding, which hinders their wide usage in clinical practice. Recently, several hemostatic powders have been developed and clinically used in the treatment of gastrointestinal bleeding. In this article, we review the risk factors for post-ESD bleeding and the recently introduced prevention methods. Moreover, we aimed to explore realistic and appropriate strategies for the prevention of post-ESD bleeding.

scholarly journals Gastrointestinal Endoscopy in Patients Receiving Antithrombotic Therapy

2021 ◽  
Vol 22 (2) ◽  
pp. 134-139
Author(s):  
Supriadi Supriadi ◽  
Titong Sugihartono
Keyword(s):  
High Risk ◽  
Antithrombotic Therapy ◽  
Gastrointestinal Endoscopy ◽  
Bleeding Risk ◽  
Thromboembolic Events ◽  
Antithrombotic Agents ◽  
Therapeutic Tool ◽  
Minimum Duration ◽  
Risk Of Bleeding ◽  
Risk For Bleeding

Gastrointestinal endoscopy is used as a diagnostic and therapeutic tool. Patients receiving antithrombotic agents are at higher risk for bleeding in this procedure. Regarding its thromboembolic versus bleeding risk, physicians should consider to adjust antithrombotic therapy in patients undergoing gastrointestinal endoscopy. Some important factors including the urgency of the procedure, bleeding risk from the procedure and antithrombotic itself, and the risk of thromboembolic events during endoscopy if antithrombotic is to be stopped need to be considered wisely. Based on recommendations of ASGE, ESGE, and BSG, endoscopic procedures were divided based on the level of emergency, namely elective and urgent. In elective endoscopy with high risk of bleeding and thromboembolism, antithrombotic therapy is given in the minimum duration required and then discontinued before the procedure. In elective endoscopy with low risk of bleeding and thromboembolism, antithrombotic can be continued as usual. In urgent endoscopy due to gastrointestinal bleeding, all antithrombotic should be discontinued. Antithrombotic can be restarted within 48 hours after the procedure if no bleeding is evident

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