title: Continued use of low-dose aspirin does not increase the risk of bleeding during or after endoscopic submucosal dissection for early gastric cancer.
abstract: BACKGROUND
  Although recent guidelines for endoscopic submucosal dissection (ESD) as treatment for early gastric cancer (EGC) recommend noninterruption of low-dose aspirin (LDA) perioperatively, this strategy is controversial. It was our practice to interrupt LDA therapy 5-7 days before to ESD until December 2010, when we instituted the new guidelines and performed ESD without interrupting LDA therapy. Our purpose in this study was to confirm the validity of noninterrupted use of LDA in patients undergoing ESD for EGC.
  
  
  METHODS
  We studied 78 consecutive patients with 94 EGCs who were routinely taking LDA and were treated by ESD at Hiroshima University Hospital between April 2005 and June 2012. The patients were of two groups: those in whom LDA was interrupted perioperatively (53 patients with 66 EGCs) and those in whom LDA was continued perioperatively (25 patients with 28 EGCs).
  
  
  RESULTS
  The complete resection rate was 92.4 % (61/66) in the LDA-interrupted group and 100 % (28/28) in the LDA-continued group. Incidences of poor bleeding control during the procedure and bleeding after procedure were 10.6 % (7/66) and 4.8 % (3/66), respectively, in the LDA-interrupted group and 7.1 % (2/28) and 3.6 % (1/28) in the LDA-continued group. Two patients in the interrupted-LDA group suffered cerebrovascular infarction before ESD, and 2 patients in this group suffered acute myocardial infarction after ESD.
  
  
  CONCLUSIONS
  Our data suggest that continued use of LDA does not increase the risk of bleeding during or after ESD for EGC and does decrease the risk of ischemic events.
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Sanomura
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Norifumi
authors.initials: N
authors.lastname: Numata
authors.forename: Makoto
authors.initials: M
authors.lastname: Higashiyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanao
authors.forename: Shigeto
authors.initials: S
authors.lastname: Yoshida
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ueno
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D004210:Dissection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012306:Risk; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin