Effect of Continued Administration of Low-dose Aspirin for Intraoperative Bleeding Control in Gastric Endoscopic Submucosal Dissection

Abstract

<b><i>Background:</i></b> The use of antithrombotic agents for the prevention of cerebro-cardioembolic events has increased, and recent guidelines have recommended the continued administration of low-dose aspirin (LDA) during endoscopic procedures with a high risk of bleeding. However, the influence of LDA on intraoperative bleeding control status during Endoscopic submucosal dissection (ESD) remains unclear. <b><i>Methods:</i></b> We examined 293 consecutive patients who underwent ESD for gastric cancers between January 2014 and February 2018. Patients administered with LDA (<i>n</i> = 52) were compared with those without antithrombotic therapy (<i>n</i> = 241; control) by propensity-score matching (PSM) concerning outcomes of ESD. <b><i>Results:</i></b> PSM analysis yielded 50 matched pairs. Comparison showed similar values for frequency of intraoperative major bleeding: 1 (0–4) times (median [range]) in the LDA group and 0 (0–5) in the control group respectively (<i>p</i> = 0.710). Others (frequency of preventive coagulation, procedure time, decrease of hemoglobin levels, en bloc resection, complete resection) were the same with a few adverse events including perforation (0%), and thromboembolism (0%). Postoperative bleeding rate was 1.9% in LDA group. Multivariate analysis indicated that location U and circumference on the posterior wall were associated with for multiple major intraoperative bleeding. <b><i>Conclusion:</i></b> The study suggests that gastric ESD can be safely accomplished without cessation of LDA.

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

“…To minimize bleeding risk, compliance with guidelines for antithrombotic therapy management is advised. Although an extensive revision of antithrombotic therapy management is outside of the scope of this technical review, it is important to state that ESD should not be performed in patients receiving thienopyridine therapy since this is associated with a higher post-procedural bleeding (PPB) risk (~25 %) [ compelling evidence suggests that low dose aspirin does not significantly increase IPB/PPB risk while its discontinuation is associated with a significantly higher risk of thrombotic events (Table 2 s) [89].…”

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

“…There have been several studies of endoscopic submucosal dissection (ESD) on continuous low dose aspirin since the previous version of this guideline. One retrospective multicentre study 87 for colonic ESD, and six retrospective studies of gastric ESD, [88][89][90][91][92][93] comparing continuation with interruption of aspirin, found no significant differences in delayed bleeding the two groups. This was confirmed by two meta-analyses which also reported that continuation of low dose aspirin does not increase the postprocedure bleeding after ESD.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

“…There have been several studies of ESD on continuous low dose aspirin since the previous version of this guideline. One retrospective multicentre study [87] for colonic ESD, and 6 retrospective studies of gastric ESD [88][89][90][91][92][93], comparing continuation with interruption of aspirin, found no significant differences in delayed bleeding the two groups. This was confirmed by two meta-analyses which also reported that continuation of low dose aspirin does not increase the post procedure bleeding after ESD [94,95].…”