title: The incidence of deep vein thrombosis in Japanese patients undergoing endoscopic submucosal dissection.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) is more invasive than other common endoscopic procedures and may increase the risk for deep vein thrombosis (DVT)/pulmonary embolism. The incidence of DVT/pulmonary embolism after ESD has not been adequately studied.
  
  
  OBJECTIVE
  To evaluate DVT incidence and disease-specific features of D-dimer levels in ESD patients.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Single academic center.
  
  
  METHODS
  This study involved 60 patients with superficial gastric neoplasms indicated for ESD.
  
  
  METHODS
  For all patients who underwent ESD, ultrasonography of the lower limbs was performed to detect DVT the day after ESD. D-dimer levels were measured 3 times: before ESD, immediately after ESD, and the day after ESD.
  
  
  METHODS
  DVT incidence after ESD.
  
  
  RESULTS
  The DVT incidence was 10.0% (6/60). At all 3 time points, D-dimer measurements were higher in patients with DVT than in patients without DVT. According to receiver operating characteristic curve analysis, the resulting cut-off value of the D-dimer level the day after ESD was 1.9 μg/mL (sensitivity 83.3%; specificity 79.6%) for ESD patients, with superior association to pre-ESD or immediately after ESD. In univariate analyses, high D-dimer levels the day after ESD and the presence of comorbidities were significantly associated with DVT development.
  
  
  CONCLUSIONS
  Single center and small number of patients.
  
  
  CONCLUSIONS
  ESD procedures have a moderate risk for venous thromboembolism. In patients undergoing ESD, D-dimer levels, especially on the day after ESD, may have specific features associated with DVT development.
authors.affiliation: Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kusunoki
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Miyake
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Shindo
authors.forename: Nobue
authors.initials: N
authors.lastname: Ueki
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kawagoe
authors.forename: Katya
authors.initials: K
authors.lastname: Gudis
authors.forename: Seiji
authors.initials: S
authors.lastname: Futagami
authors.forename: Taku
authors.initials: T
authors.lastname: Tsukui
authors.forename: Ikuyo
authors.initials: I
authors.lastname: Takagi
authors.forename: Junro
authors.initials: J
authors.lastname: Hosaka
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005773:Gastroscopy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D012372:ROC Curve; D013274:Stomach Neoplasms / Q000601:surgery*; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D