ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC TUMORS IN PATIENTS TAKING ANTITHROMBOTIC AGENTS

Abstract

Guidelines for the management of antithrombotic agents during endoscopic procedures were published by the Japan Gastroenterological Endoscopy Society in July 2012. These guidelines have permitted continuation of antithrombotic agents during endoscopic treatment in patients with arteriosclerotic disease. However, there is no evidence on the safety of endoscopic submucosal dissection (ESD) in patients with gastric tumors receiving antithrombotic agents.

It is important to obtain an accurate grasp of the patient’s general condition by prior consultations with cardiologists and neurologists, manage bleeding during and after ESD by using the appropriate devices, perform preventative coagulation for all exposed vessels upon resected ulceration, and perform second look endoscopy in order to prevent complications related to ESD in patients taking antithrombotic agents.

We performed ESD for gastric tumors without interrupting low dose aspirin (LDA) at Hiroshima University Hospital since December 2010. We compared the 52 patients who underwent ESD for gastric tumors in which LDA was interrupted in the periendoscopic period between April 2005 and November 2010, and the 90 patients in which LDA was not interrupted between December 2010 and February 2017. There were no significant differences in the rate of bleeding after the procedure and the rate of poor bleeding control during the procedure between the LDA-continued group and the LDA-interrupted group. In the LDA-interrupted group, two patients suffered cerebrovascular infarction before ESD and two patients suffered acute myocardial infarction after ESD. No ischemic events occurred in the LDA-continued group during the perioperative period. Our data support continuation of routine LDA in patients undergoing gastric ESD.