title: Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms.
abstract: BACKGROUND
  The discontinuation of antithrombotic drugs is recommended during endoscopic submucosal dissection (ESD) for gastric neoplasms; however, controversy remains as to whether antithrombotic drugs are risk factors for postoperative bleeding.
  
  
  OBJECTIVE
  To determine the risk factors for post-ESD bleeding.
  
  
  METHODS
  Single-institution, retrospective review.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  From June 2000 to December 2010, we treated 1192 gastric neoplasms in 1032 consecutive patients.
  
  
  METHODS
  The ESD procedures were performed by using the standard techniques. Antithrombotic drug therapy was principally interrupted preoperatively and was restarted when hemostasis was confirmed by second-look endoscopy.
  
  
  METHODS
  Risk factors for postoperative bleeding after ESD (early, delayed, and overall [combined] occurrence of bleeding during the first 5 postoperative days or thereafter) were analyzed by using logistic regression analysis.
  
  
  RESULTS
  Among 1166 ESD-induced ulcer lesions, overall postoperative bleeding was evident in 62 lesions (5.3%); early and delayed bleeding occurred in 30 and 32 lesions (2.6% and 2.7%), respectively. Based on a multivariate analysis, a specimen size of >40 mm was the sole independent risk factor for overall bleeding. Moreover, oral antithrombotic drug therapy was selected as independent risk factor for delayed but not early bleeding, according to the multivariate analysis. The delayed bleeding rate in patients who had a specimen size of >40 mm and who used antithrombotic drugs was 11.6%.
  
  
  CONCLUSIONS
  Retrospective design and single-site data collection.
  
  
  CONCLUSIONS
  Interruption of antithrombotic drug therapy may be adequate for preventing early post-ESD bleeding; however, reinitiating antithrombotic drug therapy is a significant independent risk factor for delayed post-ESD bleeding.
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Ryonho
authors.initials: R
authors.lastname: Koh
authors.forename: Kingo
authors.initials: K
authors.lastname: Hirasawa
authors.forename: Sei
authors.initials: S
authors.lastname: Yahara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oka
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimori
authors.forename: Manabu
authors.initials: M
authors.lastname: Morimoto
authors.forename: Kazushi
authors.initials: K
authors.lastname: Numata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kokawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Akinori
authors.initials: A
authors.lastname: Nozawa
authors.forename: Masataka
authors.initials: M
authors.lastname: Taguri
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D004210:Dissection / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents
keywords: EGC; ESD; IT; JGCA; Japanese Gastric Cancer Association; NSAID; early gastric cancer; endoscopic submucosal dissection; insulation-tipped; nonsteroidal anti-inflammatory drug