Timing of bleeding and thromboembolism associated with endoscopic submucosal dissection for gastric cancer in Japan. Issue 10 (26th May 2021)

• Record Type: Journal Article
• Authors: Shiroma, Sho; Hatta, Waku; Tsuji, Yosuke; Yoshio, Toshiyuki; Yabuuchi, Yohei; Hoteya, Shu; Tsuji, Shigetsugu; Nagami, Yasuaki; Hikichi, Takuto; Kobayashi, Masakuni; Morita, Yoshinori; Sumiyoshi, Tetsuya; Iguchi, Mikitaka; Tomida, Hideomi; Inoue, Takuya; Mikami, Tatsuya; Hasatani, Kenkei; Nishikawa, Jun; Matsumura, Tomoaki; Nebiki, Hiroko; Nakamatsu, Dai; Ohnita, Ken; Suzuki, Haruhisa; Ueyama, Hiroya; Hayashi, Yoshito; Sugimoto, Mitsushige; Yamaguchi, Shinjiro; Michida, Tomoki; Yada, Tomoyuki; Asahina, Yoshiro; Narasaka, Toshiaki; Kuribayashi, Shiko; Kiyotoki, Shu; Mabe, Katsuhiro; Fujishiro, Mitsuhiro; Masamune, Atsushi; Fujisaki, Junko;
• Is Part Of: Journal of gastroenterology and hepatology. Volume 36:Issue 10(2021)
• Page Start: 2769
• Page End: 2777
• Publication Date: 2021-05-26
• Subjects: bleeding -- endoscopic submucosal dissection -- gastric cancer -- thromboembolism; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.15536
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background and Aim: This study aimed to reveal the timing of bleeding and thromboembolism associated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Methods: We retrospectively reviewed 10, 320 patients who underwent ESD for EGC during November 2013–October 2016. We evaluated overall bleeding rates and their inter‐group differences. Factors associated with early/late (cut‐off 5 days) bleeding and thromboembolism frequency and its association with the intake of antithrombotic agents were investigated. Results: Overall, the post‐ESD bleeding rate was 4.7% (489/10 320); the median time to post‐ESD bleeding was 4 days. The post‐ESD bleeding rates were 3.2%, 8.7%, 15.5%, and 29.9% in those not taking antithrombotic agents, those taking antiplatelet agents, those taking anticoagulants (ACs), and those taking antiplatelet agents and ACs. Warfarin (odds ratio [OR], 9.16), direct oral ACs (OR, 4.16), chronic kidney disease with hemodialysis (OR, 2.93), thienopyridine (OR, 2.25), aspirin (OR, 1.66), tumor size >30 mm (OR, 1.86), multiple tumors' resection (OR, 1.54), and tumor in the lower third of the stomach (OR, 1.40) were independent risk factors for early bleeding. The independent risk factors for late bleeding were direct oral ACs (OR, 7.42), chronic kidney disease with hemodialysis (OR, 4.99), warfarin (OR, 3.90), thienopyridine (OR, 3.09), liver cirrhosis (OR, 2.43), cilostazol (OR, 1.93), aspirin (OR, 1.92), ischemic heart disease (OR, 1.77), and male sex (OR, 1.65). There were three (0.03%) thromboembolic events (cerebral infarction = 2, transient ischemic attack = 1). Conclusion: We revealed the timing of bleeding and risk factors for early/late bleeding and showed the thromboembolism frequency associated with ESD for EGC.