Continuation of antithrombotic therapy may be associated with a high incidence of colonic post-polypectomy bleeding.
OBJECTIVE
Post-polypectomy bleeding (PPB) is the most common complication of endoscopic procedures. To reduce the risk of thromboembolic incidents, Japanese guidelines for gastroenterological endoscopy were revised to indicate that antithrombotic agents were not to be discontinued for endoscopic treatment. However, carrying out endoscopic procedures under antithrombotic medication potentially increases the incidence of hemorrhagic complications. The present study investigated the impact of the revised guidelines on the frequency of complications after colonoscopic procedures.


METHODS
The surveillance period comprised the year before the initiation of the new guidelines (2012), which served as a control period, and 2 years after initiation of the new guidelines (2013 and 2014). During the control period, 3955 cases were examined colonoscopically and 1601 lesions were treated endoscopically. During the 2-year period under the new guidelines, 8749 colonoscopies and 3768 endoscopic treatments were carried out. Changes in treatment methods and rates of complications were compared.


RESULTS
PPB rate was not significantly different before and after the revision (0.87% vs 1.01%). With the new guidelines, PPB rates in antithrombotic non-users and users were 0.60% and 3.13%, respectively (OR 5.11, P = 0.000). Multivariable analysis showed that the risks for PPB were as follows: heparin bridging therapy (OR 6.34, P = 0.0002); low-dose aspirin (LDA) continuation (OR 5.30, P = 0.0079); and lesion size (OR 1.06, P < 0.0001).


CONCLUSIONS
The present study showed that the overall PPB rate under the new guidelines was not significantly higher when compared with the previous data obtained before the new guidelines were introduced.
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Tomoyoshi
T
Shibuya
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Osamu
O
Nomura
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Tomohiro
T
Kodani
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Takashi
T
Murakami
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Hirofumi
H
Fukushima
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Yuzuru
Y
Tajima
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Kohei
K
Matsumoto
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Hideaki
H
Ritsuno
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Hiroya
H
Ueyama
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Yoshihiro
Y
Inami
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Dai
D
Ishikawa
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Kenshi
K
Matsumoto
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Naoto
N
Sakamoto
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Taro
T
Osada
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Akihito
A
Nagahara
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Tatsuo
T
Ogihara
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Sumio
S
Watanabe
D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D012189:Retrospective Studies
D005343:Fibrinolytic Agents
antithrombotic agent; colonoscopy; post-polypectomy bleeding