Izumikawa K, et al. - The incidence of bleeding after endoscopic submucosal dissection (ESD) in antithrombotic drug users was analyzed by the experts, along with the status of ulcers. It was discovered that the antithrombotic treatment presented as a risk factor for post-ESD bleeding regardless of the second-look endoscopy (SLE) being scheduled 5 days after ESD. The occurrence of later phase post-ESD bleeding was found in 13.2% of the patients under antithrombotic treatment even after prophylactic hemostasis for high-risk ulcers.

Methods

• An inspection was performed of 299 lesions in 299 patients subjected to ESD for gastric neoplasms.
• Patients received a double dose of proton pump inhibitors after ESD.
• SLE was planned 5 days after ESD and post-ESD bleeding occurring before SLE was defined as early phase post-ESD bleeding, whereas bleeding after SLE was defined as later phase post-ESD bleeding.
• Forrest IIa and IIb ulcers were defined as high-risk ulcers requiring prophylactic hemostasis.
• Risk factors for post-ESD bleeding were determined, emphasizing on the use of antithrombotic agents and the presence of high-risk ulcers requiring prophylactic hemostasis during SLE.

Results

• The occurrence of early phase post-ESD bleeding was noted in 2.3% of non-users (5/218) and 6.2% of users of antithrombotic agents (5/81) under a double dose of proton pump inhibitors.
• Data revealed the presence of high-risk ulcers in 19.0% of the cases during scheduled SLE (55/289).
• In 5.5% of cases [2.8% of non-users (6/213) and 13.2% of users of antithrombotic agents (10/76)], later phase bleeding was found.
• As per the Cox regression analysis, the risk factor for post-ESD bleeding was found to be the antithrombotic treatment (HR: 3.56; 95% CI: 1.63–8.02, p=0.002) alone.
• Findings demonstrated a statistically marked increase in bleeding in the later phase in patients under antithrombotic therapy vs those not receiving any antithrombotic agents (p=0.001) among patients with high-risk ulcers.