Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2019; 25(4): 457-468
Published online Jan 28, 2019. doi: 10.3748/wjg.v25.i4.457
Feasibility of gastric endoscopic submucosal dissection with continuous low-dose aspirin for patients receiving dual antiplatelet therapy
Hideaki Harada, Satoshi Suehiro, Daisuke Murakami, Ryotaro Nakahara, Takuya Nagasaka, Tetsuro Ujihara, Ryota Sagami, Yasushi Katsuyama, Kenji Hayasaka, Yuji Amano
Hideaki Harada, Satoshi Suehiro, Daisuke Murakami, Ryotaro Nakahara, Takuya Nagasaka, Tetsuro Ujihara, Ryota Sagami, Yasushi Katsuyama, Kenji Hayasaka, Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba 270-2232, Japan
Yuji Amano, Department of Endoscopy, New Tokyo Hospital, Matsudo, Chiba 270-2232, Japan
Author contributions: Harada H wrote the manuscript and analyzed the data. Amano Y gave the final approval of the manuscript. All the other authors collected the data, check the manuscript, and suggested improvement.
Institutional review board statement: This study was reviewed and approved by the New Tokyo Hospital Institutional Review Committee.
Informed consent statement: The procedure participant provided informed written consent.
Conflict-of-interest statement: There are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hideaki Harada, MD, Chief Doctor, Department of Gastroenterology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan. nerimaendo@hotmail.co.jp
Telephone: +81-47-7118700 Fax: +81-47-3928718
Received: November 29, 2018
Peer-review started: November 29, 2018
First decision: December 12, 2018
Revised: December 19, 2018
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: January 28, 2019
Processing time: 58 Days and 11.8 Hours
Abstract
BACKGROUND

Endoscopic submucosal dissection (ESD) for gastric neoplasms during continuous low-dose aspirin (LDA) administration is generally acceptable according to recent guidelines. This retrospective study aimed to investigate the effect of continuous LDA on the postoperative bleeding after gastric ESD in patients receiving dual antiplatelet therapy (DAPT).

AIM

To investigate the feasibility of gastric ESD with continuous LDA in patients with DAPT.

METHODS

A total of 597 patients with gastric neoplasms treated with ESD between January 2010 and June 2017 were enrolled. The patients were categorized according to type of antiplatelet therapy (APT).

RESULTS

The postoperative bleeding rate was 6.9% (41/597) in all patients. Patients were divided into the following two groups: no APT (n = 443) and APT (n = 154). APT included single-LDA (n = 95) and DAPT (LDA plus clopidogrel, n = 59) subgroups. In the single-LDA and DAPT subgroups, 56 and 39 patients were received continuous LDA, respectively. The bleeding rate with continuous single-LDA (10.7%) was similar to that with discontinuous single-LDA (10.3%) (P > 0.99). Although the bleeding rate with continuous LDA in patients receiving DAPT (23.1%) was higher than that with discontinuous LDA in patients receiving DAPT (5.0%), no significant difference was observed (P = 0.141).

CONCLUSION

The bleeding rate with continuous LDA in patients receiving DAPT was not statistically different from that with discontinuous LDA in patients receiving DAPT. Therefore, continuous LDA administration may be acceptable for ESD in patients receiving DAPT, although patients should be carefully monitored for possible bleeding.

Keywords: Dual antiplatelet therapy; Endoscopic submucosal dissection; Low-dose aspirin; Postoperative bleeding; Thienopyridine

Core tip: Antithrombotic therapy is considered as an independent risk factor for postoperative bleeding after gastric endoscopic submucosal dissection (ESD). In the latest guideline, low-dose aspirin (LDA) should be continued for patients with a high risk of thrombosis who undergo ESD. In this retrospective study, we aimed to investigate the effect of continuous LDA on postoperative bleeding after gastric ESD in patients receiving dual antiplatelet therapy.