Is gastroduodenal biopsy safe in patients receiving aspirin and clopidogrel?: a prospective, randomized study involving 630 biopsies.
OBJECTIVE
To assess prospectively the bleeding risk attributable to gastroduodenal biopsy in subjects taking antiplatelet medications.


BACKGROUND
No prospective data exist regarding the bleeding risk attributable to endoscopic biopsy in patients taking antiplatelet agents. A majority of Western endoscopists withdraw antiplatelet agents before upper endoscopy, despite expert guidelines to the contrary.


METHODS
We performed a prospective, single-blind, randomized study in healthy volunteers participating in a larger study regarding the effect of antiplatelet agents on gastroduodenal mucosal healing. Multiple gastroduodenal biopsies were performed during 2 esophagogastroduodenoscopy in subjects dosed with aspirin enteric-coated 81 mg once daily or clopidogrel 75 mg once daily. Data for endoscopic bleeding, clinical bleeding, blood vessel size, and depth of biopsy in histology specimens were collected.


RESULTS
Four hundred and five antral biopsies and 225 duodenal biopsies were performed during 90 esophagogastroduodenoscopy in 45 subjects receiving aspirin or clopidogrel. Median maximum blood vessel diameter per biopsy was 31.9 μ (range: 9.2 to 133.8). About 50.8% of biopsy specimens breached the muscularis mucosa. In the clopidogrel group, no bleeding events were noted after 350 biopsies [upper confidence limit (UCL) for probability of bleeding=0.0085]. In the aspirin group, there were no clinical events (UCL=0.0106) and one minor endoscopic bleeding event (UCL=0.0169).


CONCLUSIONS
Consistent with expert guidelines, the absolute risk attributable to gastroduodenal biopsy in adults taking antiplatelet agents seems to be low. Half of routine biopsies enter submucosa. The largest blood vessels avulsed during biopsy correspond to midsized and large arterioles and venules.
Whitson
Matthew J
MJ
Division of Gastroenterology, Department of Medicine, Mount Sinai Medical Center, New York, NY 10075, USA.
Dikman
Andrew E
AE
von Althann
Caroline
C
Sanyal
Shefali
S
Desai
Jay C
JC
Bamji
Neville D
ND
Kornacki
Susan
S
Harpaz
Noam
N
Bodian
Carol A
CA
Cohen
Lawrence B
LB
Miller
Kenneth M
KM
Aisenberg
James
J
D000328:Adult; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy / Q000009:adverse effects*; D000077144:Clopidogrel; D004386:Duodenum / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011706:Pyloric Antrum / Q000601:surgery; D012307:Risk Factors; D016037:Single-Blind Method; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin