Continued Use of a Single Antiplatelet Agent Does Not Increase the Risk of Delayed Bleeding After Colorectal Endoscopic Submucosal Dissection

Abstract

BackgroundWith the aging of the population and rising incidence of thromboembolic events, the usage of antiplatelet agents is also increasing. There are few reports yet on the management of antiplatelet agents for patients undergoing colorectal endoscopic submucosal dissection (ESD).AimsThe aim of this study is to evaluate whether continued administration of antiplatelet agents is associated with an increased rate of delayed bleeding after colorectal ESD.MethodsA total of 1022 colorectal neoplasms in 927 patients were dissected at Yokohama City University Hospital and its three affiliate hospitals between July 2012 and June 2017. We included the data of 919 lesions in the final analysis. The lesions were divided into three groups: the no-antiplatelet group (783 neoplasms), the withdrawal group (110 neoplasms), and the continuation group (26 neoplasms).ResultsAmong the 919 lesions, bleeding events occurred in a total of 31 (3.37%). The rate of bleeding after ESD was 3.3% (26/783), 4.5% (5/110), and 0% (0/26), respectively. There were no significant differences in the rate of bleeding after ESD among the three groups (the withdrawal group vs. the no-antiplatelet group, the continuation group vs. the no-antiplatelet group, and the withdrawal group vs. the continuation group).ConclusionsContinued administration of antiplatelet agents is not associated with any increase in the risk of delayed bleeding after colorectal ESD. Prospective, randomized studies are necessary to determine whether treatment with antiplatelet agents must be interrupted prior to colorectal ESD in patients who are at a high risk of thromboembolic events.Electronic supplementary materialThe online version of this article (10.1007/s10620-017-4843-0) contains supplementary material, which is available to authorized users.

Bleeding after endoscopic submucosal dissection of gastric lesions

“…[26][27][28] Therefore, guidelines recommend continuous aspirin use during gastric ESD to reduce the incidence of thrombotic events. 29,30 Other studies indicate that taking a single antiplatelet drug is not associated with post-ESD bleeding, 28,31 but for those receiving dual antiplatelet therapy the incidence of hemorrhage is significantly increased. 32 However, Nam et al's study 9 showed that clopidogrel could significantly increase the risks of both early (with 24 h after ESD) and delayed post-ESD bleeding.…”

Safety and efficacy of a new cold snare technique with clipping for colorectal angioectasia

“…CSA is a challenging treatment that has not been reported so far; therefore, we performed clipping in all cases for patient safety. DPPB was defined as reduction in hemoglobin level by at least 2 g/dL below the most recent preoperative level or need for endoscopic hemostasis and/or blood transfusion and/or massive melena within 2 weeks of the procedure 8 9 . Immediate bleeding that necessitated hemostatic clipping was defined as spurting or oozing that continued for more than 30 seconds 9 .…”

Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy

“…[56][57][58][59][60][61][62][63][64] While some studies reported that the risk of post-ESD bleeding was increased with persistent use of aspirin before ESD, others reported no increase in the bleeding rate regardless of aspirin discontinuation. [56][57][58][59][60][61][62][63][64] In a Korean study that investigated the bleeding rate after gastric ESD, the bleeding rates were 11.6% and 5.9% in the antiplatelet-continuation group and the withdrawal group, respectively; however, these rates were not statistically significant. 61 However, in another Korean study, the bleeding rate in the continuation group was significantly higher than that of the withdrawal group after gastric ESD (21.1% and 3.6%, respectively).…”