The safety of upper gastrointestinal endoscopic biopsy in patients receiving antithrombic drugs. A single-centre prospective observational study

Abstract

Introduction: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines on gastroenterological endoscopy in patients undergoing antithrombotic therapy, although the safety of endoscopic procedures in patients receiving antithrombotic drugs has yet to be sufficiently studied. Aim: This study evaluates the safety of upper gastroenterological endoscopic biopsy in patients receiving antithrombotic drugs. We evaluated the prospective observational safety of endoscopic biopsy performed in the endoscopy unit of our patients using antithrombotic drugs. Material and methods: Oesophagogastroduodenoscopies (OGD) and biopsies performed at a single endoscopy unit between July 2018 and February 2019 were examined in this prospective observational study. Patients receiving antithrombotic drugs due to cardiovascular and neurological reasons, who underwent an endoscopic mucosal biopsy for diagnostic purposes, were included in the study. Results: The study was completed with 166 patients who underwent an endoscopic biopsy, from whom a total of 327 biopsies taken. The patients were examined in two groups: those "receiving antithrombotic drugs" and those who had "stopped taking antithrombotic drugs". There was no statistically significant difference between the two groups with respect to bleeding. Conclusions: This prospective observational study showed that performing an endoscopic biopsy without the cessation of antithrombotic drugs does not increase bleeding risk. Low-risk procedures, such as endoscopic mucosal biopsies, can be performed confidently by experienced endoscopists.

Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant gastric ulcer: a multicenter retrospective cohort study

“…However, patients with ANVUGIB requiring EG are often more complex, and the guidelines do not specify the circumstances under which biopsy of a suspected malignant lesion is performed, a situation in which the clinician mostly operates on the basis of their own clinical experience [3,12,16]. Clinicians often encounter the following difficulties in making decisions [17][18][19][20]: (1) Can biopsy be performed in patients with active bleeding under EG? (2) What are the levels of Forrest classification for active bleeding during EG that can be biopsied?…”

International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy

“…To update the evidence for the previous KSGE guidelines, we performed a literature search and identified eight retrospective and prospective cohort studies. 53,59,[73][74][75][76][77][78] Various low-risk endoscopic procedures, such as double-balloon enteroscopy, 73,78 diagnostic endoscopy, 53,75 endoscopic papillary large balloon dilatation, 76 or endoscopic biopsy, 59,77 were evaluated to determine whether warfarin could be continued or discontinued before the procedures. All included studies indicated that the overall rate of early or delayed hemorrhage did not differ between the warfarin interruption and non-interruption groups.…”

Adverse events associated with EGD and EGD-related techniques

“…11 Importantly, the available body of evidence suggests no significant differences in clinically relevant delayed bleeding between patients undergoing diagnostic EGD who do or do not take antithrombotic agents. [11][12][13][14][15] Also of note, in patients taking antithrombotic agents at baseline, available evidence suggests no differences in clinically significant bleeding outcomes when EGD (with or without biopsy sampling) is performed after appropriate periprocedural cessation of these agents 16 versus when they are continued leading up to and after the procedure. 11,17,18 Based on these and other data, the ASGE guideline on management of antithrombotic agents concludes that there is a low overall risk of bleeding during diagnostic EGD with or without biopsy sampling in patients on all antithrombotic medication.…”