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Gastric Cancer
Erschienen in:

27.05.2022 | Original Article

Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis

verfasst von: Taro Iwatsubo, Toshihisa Takeuchi, Akitoshi Hakoda, Yasuhiro Fujiwara, Yasuaki Nagami, Yuji Naito, Osamu Dohi, Tetsuya Tatsuta, Manabu Sawaya, Xiaoyi Jin, Tomoyuki Koike, Mitsushige Sugimoto, Masaki Murata, Kenta Hamada, Hiroyuki Okada, Hideki Kobara, Taiga Chiyo, Norimasa Yoshida, Naoya Tomatsuri, Tomoki Inaba, Shigenao Ishikawa, Akihito Nagahara, Hiroya Ueyama, Eriko Koizumi, Katsuhiko Iwakiri, Kazuhiro Mizukami, Kazunari Murakami, Takahisa Furuta, Takahiro Suzuki, Naotaka Ogasawara, Kunio Kasugai, Hajime Isomoto, Koichiro Kawaguchi, Kotaro Shibagaki, Hiromi Kataoka, Takaya Shimura, Hidekazu Suzuki, Toshihiro Nishizawa, Kazuhide Higuchi

Erschienen in: Gastric Cancer | Ausgabe 5/2022

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Abstract

Background

The risk of bleeding after gastric endoscopic submucosal dissection (ESD) in antithrombotic agent users has increased, and its management remains a problem. Second-look endoscopy (SLE) following gastric ESD in antithrombotic agent users may be effective in preventing delayed bleeding, but this requires elucidation. Therefore, this study aimed to investigate the efficacy of SLE in reducing bleeding after gastric ESD in patients receiving antithrombotic agents.

Methods

This retrospective cohort study was conducted at 19 referral hospitals in Japan. A total of 1,245 patients who were receiving antithrombotic agents underwent gastric ESD between January 2013 and July 2018. The incidence of delayed bleeding was compared between SLE and non-SLE groups using propensity score matching analysis.

Results

Overall, 858 patients (SLE group, 657 patients; non-SLE group, 201 patients) were analyzed. After matching, 198 pairs were created. Delayed bleeding occurred in 10 patients (5.1%) in the SLE group and 16 patients (8.1%) in the non-SLE group [odds ratio (OR) 0.605, 95% confidence interval (CI) 0.23–1.46, p = 0.310]. In the subgroup analysis, SLE reduced the incidence of delayed bleeding in patients receiving heparin bridging therapy (6.3% and 40.0%, respectively; p = 0.004). In the SLE group, prophylactic coagulation did not significantly reduce delayed bleeding compared to the no treatment group (14.6% and 8.6%, respectively; p = 0.140).

Conclusions

SLE was ineffective in reducing bleeding after gastric ESD in antithrombotic agent users, overall. A prospective comparative study is warranted to definitively evaluate the effectiveness of SLE in reducing bleeding in high-risk patients.
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Metadaten
Titel
Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis
verfasst von
Taro Iwatsubo
Toshihisa Takeuchi
Akitoshi Hakoda
Yasuhiro Fujiwara
Yasuaki Nagami
Yuji Naito
Osamu Dohi
Tetsuya Tatsuta
Manabu Sawaya
Xiaoyi Jin
Tomoyuki Koike
Mitsushige Sugimoto
Masaki Murata
Kenta Hamada
Hiroyuki Okada
Hideki Kobara
Taiga Chiyo
Norimasa Yoshida
Naoya Tomatsuri
Tomoki Inaba
Shigenao Ishikawa
Akihito Nagahara
Hiroya Ueyama
Eriko Koizumi
Katsuhiko Iwakiri
Kazuhiro Mizukami
Kazunari Murakami
Takahisa Furuta
Takahiro Suzuki
Naotaka Ogasawara
Kunio Kasugai
Hajime Isomoto
Koichiro Kawaguchi
Kotaro Shibagaki
Hiromi Kataoka
Takaya Shimura
Hidekazu Suzuki
Toshihiro Nishizawa
Kazuhide Higuchi
Publikationsdatum
27.05.2022
Verlag
Springer Nature Singapore
Erschienen in
Gastric Cancer / Ausgabe 5/2022
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-022-01303-y

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