Timing of bleeding and thromboembolism associated with endoscopic submucosal dissection for gastric cancer in Japan

Sho Shiroma, Waku Hatta, Yosuke Tsuji, Toshiyuki Yoshio, Yohei Yabuuchi, Shu Hoteya, Shigetsugu Tsuji, Yasuaki Nagami, Takuto Hikichi, Masakuni Kobayashi, Yoshinori Morita, Tetsuya Sumiyoshi, Mikitaka Iguchi, Hideomi Tomida, Takuya Inoue, Tatsuya Mikami, Kenkei Hasatani, Jun Nishikawa, Tomoaki Matsumura, Hiroko NebikiDai Nakamatsu, Ken Ohnita, Haruhisa Suzuki, Hiroya Ueyama, Yoshito Hayashi, Mitsushige Sugimoto, Shinjiro Yamaguchi, Tomoki Michida, Tomoyuki Yada, Yoshiro Asahina, Toshiaki Narasaka, Shiko Kuribayashi, Shu Kiyotoki, Katsuhiro Mabe, Mitsuhiro Fujishiro, Atsushi Masamune, Junko Fujisaki

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aim: This study aimed to reveal the timing of bleeding and thromboembolism associated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Methods: We retrospectively reviewed 10,320 patients who underwent ESD for EGC during November 2013–October 2016. We evaluated overall bleeding rates and their inter-group differences. Factors associated with early/late (cut-off 5 days) bleeding and thromboembolism frequency and its association with the intake of antithrombotic agents were investigated. Results: Overall, the post-ESD bleeding rate was 4.7% (489/10 320); the median time to post-ESD bleeding was 4 days. The post-ESD bleeding rates were 3.2%, 8.7%, 15.5%, and 29.9% in those not taking antithrombotic agents, those taking antiplatelet agents, those taking anticoagulants (ACs), and those taking antiplatelet agents and ACs. Warfarin (odds ratio [OR], 9.16), direct oral ACs (OR, 4.16), chronic kidney disease with hemodialysis (OR, 2.93), thienopyridine (OR, 2.25), aspirin (OR, 1.66), tumor size >30 mm (OR, 1.86), multiple tumors' resection (OR, 1.54), and tumor in the lower third of the stomach (OR, 1.40) were independent risk factors for early bleeding. The independent risk factors for late bleeding were direct oral ACs (OR, 7.42), chronic kidney disease with hemodialysis (OR, 4.99), warfarin (OR, 3.90), thienopyridine (OR, 3.09), liver cirrhosis (OR, 2.43), cilostazol (OR, 1.93), aspirin (OR, 1.92), ischemic heart disease (OR, 1.77), and male sex (OR, 1.65). There were three (0.03%) thromboembolic events (cerebral infarction = 2, transient ischemic attack = 1). Conclusion: We revealed the timing of bleeding and risk factors for early/late bleeding and showed the thromboembolism frequency associated with ESD for EGC.

Original languageEnglish
JournalJournal of Gastroenterology and Hepatology (Australia)
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • bleeding
  • endoscopic submucosal dissection
  • gastric cancer
  • thromboembolism

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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