2020 Volume 50 Issue 2 Pages 87-93
Background: Patients with gastrointestinal cancer tend to develop thrombotic diseases. Endoscopic submucosal dissection (ESD) to treat gastrointestinal lesions is thought to put patients at possible risk for thrombosis because the same posture must be maintained for long periods.
Objectives: We aimed to clarify the incidence of thrombosis and hypercoagulation after ESD to treat gastrointestinal neoplasms.
Methods: We selected 565 consecutive patients with esophageal (76 patients), gastric (274 patients) or colorectal (215 patients) neoplasms that were treated by ESD between April, 2010 and October, 2018. We determined the prevalence of thrombosis at six months after ESD from medical charts and compared plasma d-dimer values (when available) before and immediately after ESD.
Results: Thrombotic events did not arise in any patients after ESD. Pre- and postoperative ddimer was found in 100 patients. Values for d-dimer were high before, and significantly elevated after ESD in 24 and 35 of 100 patients, respectively. Multivariate analysis associated antithrombotic agents and age ≥75 years with high preoperative d-dimer values, and identified upper gastrointestinal lesions and underlying chronic kidney disease as significant factors related to elevated ddimer level.
Conclusions: We found that ESD is safe and that early-stage gastrointestinal cancer is not a high risk for thrombosis. Upper gastrointestinal lesions and chronic kidney disease seem to be predisposing factors for hypercoagulation states, indicating that endoscopists should consider the possibility of thrombosis after ESD in such patients.
