Feasibility of gastric endoscopic submucosal dissection with continuous low-dose aspirin for patients receiving dual antiplatelet therapy

doi:10.3748/wjg.v25.i4.457

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jan 28, 2019; 25(4): 457-468
Published online Jan 28, 2019. doi: 10.3748/wjg.v25.i4.457

Table 1 Baseline characteristics and therapeutic outcomes in all patients who underwent gastric endoscopic submucosal dissection

	All patients (n = 597)
Age, mean (SD), yr	72.3 (8.815)
Sex, male, n (%)	414 (69.3)
BMI, mean (SD), yr	22.6 (3.424)
Comorbidity, n (%)	379 (63.5)
Hypertension	307 (51.4)
Diabetes mellitus	114 (19.1)
Renal failure	17 (2.8)
Coronary artery diseases	142 (23.8)
Longitudinal location, n (%)
Upper	90 (15.1)
Middle	250 (41.9)
Lower	257 (43.0)
Macroscopic findings, n (%)
Depressed	275 (46.1)
Non-depressed	322 (53.9)
Pathological findings, n (%)¹
Differentiated	578 (96.8)
Undifferentiated	19 (3.2)
Depth of invasion, n (%)
Mucosa	530 (88.8)
Submucosa	67 (11.2)
LDA intake, n (%)	154 (25.8)
Continuous LDA	95 (16.4)
Continuous single-LDA	56 (9.3)
DAPT (LDA with clopidogrel), n (%)	59 (9.9)
Continuous LDA on DAPT, n (%)	39 (6.5)
Specimen size, median (IQR), mm	32.9 (24-40)
Complete resection, n (%)	557 (93.3)
Curative resection, n (%)	524 (87.8)
Postoperative bleeding, n (%)	41 (6.9)
Delayed bleeding	16 (2.7)

¹Differentiated, adenoma/well or moderately differentiated adenocarcinoma/papillary adenocarcinoma; undifferentiated, signet-ring cell carcinoma/poorly differentiated adenocarcinoma/mucinous adenocarcinoma. BMI: Body mass index; DAPT: Dual antiplatelet therapy; ESD: Endoscopic submucosal dissection; IQR: Interquartile range; LDA: Low-dose aspirin; SD: Standard deviation.

Table 2 Comparison of characteristics among patients receiving low-dose aspirin in the continuous low-dose aspirin group and the discontinuous low-dose aspirin group

	Continuous LDA (n = 95)	Discontinuous LDA (n = 59)	P value
Age, mean (SD), yr	75.5 (6.841)	75.7 (7.684)	0.856
Sex, male, n (%)	71 (74.7)	46 (78.0)	0.701
BMI, mean (SD), yr	22.7 (3.395)	23.1 (3.079)	0.382
Comorbidity, n (%)
Hypertension	70 (73.7)	39 (66.1)	0.364
Diabetes mellitus	32 (33.7)	21 (35.6)	0.862
Renal failure	7 (7.4)	4 (6.8)	> 0.99
Coronary artery diseases	78 (82.1)	42 (71.2)	0.161
Longitudinal location, n (%)
Upper	18 (18.9)	7 (11.9)	0.429
Middle	40 (42.1)	24 (40.7)
Lower	37 (39.0)	28 (47.5)
Macroscopic findings, n (%)
Depressed	31 (32.6)	21 (35.6)	0.729
Non-depressed	64 (67.4)	38 (64.4)	0.729

BMI: Body mass index; LDA: Low dose aspirin; SD: Standard deviation.

Table 3 Comparison of therapeutic outcomes among patients receiving low-dose aspirin in the continuous low-dose aspirin group and the discontinuous low-dose aspirin group

	Continuous LDA (n = 95)	Discontinuous LDA (n = 59)	P value
Pathological findings, n (%)¹
Differentiated	94 (98.9)	58 (98.3)	> 0.99
Undifferentiated	1 (1.1)	1 (1.7)	> 0.99
Depth of invasion, n (%)
Mucosa	80 (84.2)	52 (88.1)	0.637
Submucosa	15 (15.8)	7 (11.9)	0.637
Specimen size, median (IQR), mm	30 (25-39)	33 (25-41.5)	0.944
Complete resection, n (%)	91 (95.8)	57 (96.6)	> 0.99
Curative resection, n (%)	85 (89.5)	54 (91.5)	0.785
Postoperative bleeding, n (%)	15 (15.8)	5 (8.5)	0.225

Table 4 Comparison of characteristics adjusted among patients receiving single-low-dose aspirin in the continuous low-dose aspirin group and the discontinuous low-dose aspirin group

	Continuous LDA (n = 56)	Discontinuous LDA (n = 39)	P value
Age, mean (SD), yr	76.5 (7.628)	74.8 (5.961)	0.255
Sex, male, n (%)	37 (66.1)	32 (82.1)	0.105
BMI, mean (SD), yr	22.2 (3.029)	23.6 (2.958)	0.025
Comorbidity, n (%)
Hypertension	41 (73.2)	24 (61.5)	0.266
Diabetes mellitus	13 (23.2)	13 (33.3)	0.351
Renal failure	3 (5.4)	1 (2.6)	0.642
Coronary artery diseases	41 (73.2)	25 (64.1)	0.372
Longitudinal location, n (%)
Upper	8 (14.3)	4 (10.3)	0.643
Middle	28 (50.0)	17 (43.6)
Lower	20 (35.7)	18 (46.2)
Macroscopic findings, n (%)
Depressed	20 (35.7)	16 (41.0)	0.669
Non-depressed	36 (64.3)	23 (59.0)	0.669

BMI: Body mass index; LDA: Low-dose aspirin; SD: Standard deviation.

Table 5 Comparison of therapeutic outcomes among patients receiving single- low-dose aspirin in the continuous low-dose aspirin group and the discontinuous low-dose aspirin group

	Continuous LDA (n = 56)	Discontinuous LDA (n = 39)	P value
Pathological findings, n (%)¹
Differentiated	55 (98.2)	39 (100)	> 0.99
Undifferentiated	1 (1.8)	0 (0)	> 0.99
Depth of invasion, n (%)
Mucosa	50 (89.3)	33 (84.6)	0.542
Submucosa	6 (10.7)	6 (15.4)	0.542
Specimen size, median (IQR), mm	28 (22-37.3)	31 (25-43.5)	0.440
Complete resection, n (%)	53 (94.6)	37 (94.9)	> 0.99
Curative resection, n (%)	52 (92.9)	34 (87.2)	0.480
Postoperative bleeding, n (%)	6 (10.7)	4 (10.3)	> 0.99

Table 6 Comparison of characteristics among patients receiving dual antiplatelet therapy in the continuous low-dose aspirin group and the discontinuous low-dose aspirin group

	Continuous LDA (n = 39)	Discontinuous LDA (n = 20)	P value
Age, mean (SD), yr	74.7 (7.743)	77.4 (7.665)	0.216
Sex, male, n (%)	34 (87.2)	14 (70.0)	0.159
BMI, mean (SD), yr	23.5 (3.765)	22.4 (3.232)	0.273
Comorbidity, n (%)
Hypertension	29 (74.4)	15 (75.0)	> 0.99
Diabetes mellitus	19 (48.7)	8 (40.0)	0.589
Renal failure	4 (10.3)	3 (15.0)	0.679
Coronary artery diseases	37 (94.9)	17 (85.0)	0.325
Longitudinal location, n (%)
Upper	10 (25.6)	3 (15.0)	0.726
Middle	12 (30.8)	7 (35.0)
Lower	17 (43.6)	10 (50.0)
Macroscopic findings, n (%)
Depressed	11 (28.2)	5 (25.0)	> 0.99
Non-depressed	28 (71.8)	15 (75.0)	> 0.99

BMI: Body mass index; LDA: Low-dose aspirin; SD: Standard deviation.

Table 7 Comparison of therapeutic outcomes among patients receiving dual antiplatelet therapy in the continuous low-dose aspirin group and the discontinuous low-dose aspirin group

	Continuous LDA (n = 39)	Discontinuous LDA (n = 20)	P value
Pathological findings, n (%)¹
Differentiated	39 (100)	19 (95.0)	0.339
Undifferentiated	0 (0)	1 (5.0)	0.339
Depth of invasion, n (%)
Mucosa	30 (76.9)	19 (95.0)	0.141
Submucosa	9 (23.1)	1 (5.0)	0.141
Specimen size, median (IQR), mm	34 (29.5-40.0)	35 (24.3-36.3)	0.373
Complete resection, n (%)	38 (97.4)	20 (100)	> 0.99
Curative resection, n (%)	33 (84.6)	20 (100)	0.09
Postoperative bleeding, n (%)	9 (23.1)	1 (5.0)	0.141

Citation: Harada H, Suehiro S, Murakami D, Nakahara R, Nagasaka T, Ujihara T, Sagami R, Katsuyama Y, Hayasaka K, Amano Y. Feasibility of gastric endoscopic submucosal dissection with continuous low-dose aspirin for patients receiving dual antiplatelet therapy. World J Gastroenterol 2019; 25(4): 457-468
URL: https://www.wjgnet.com/1007-9327/full/v25/i4/457.htm
DOI: https://dx.doi.org/10.3748/wjg.v25.i4.457