title: Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users.
abstract: The Japan Gastroenterological Endoscopy Society updated its guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment in July 2012. However, the safety of endoscopic procedures in antithrombotic drug users has not been fully investigated.
  
  
  
  To evaluate the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users.
  
  
  
  From September 2013 to September 2015, patients who were taking antithrombotic drugs and who underwent upper gastrointestinal endoscopic procedures were prospectively enrolled at five hospitals. Incidences of bleeding and thrombosis during endoscopic procedures were evaluated.
  
  
  
  A total of 270 patients [221 for endoscopic mucosal biopsy and 49 for endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) were enrolled. The bleeding rate was 0.9% for endoscopic mucosal biopsy and 22% for EMR/ESD, respectively. The bleeding rate after endoscopic mucosal biopsy was not significantly high, even if antithrombotic drugs were continued (0 vs. 1%, P > 0.99), while it was significantly higher among multiple antithrombotic drug users than single drug users (5.9 vs. 0%, P < 0.05). The bleeding rate after EMR/ESD was also higher among multiple antithrombotic drug users than single drug users, but was not significantly different (33 vs. 14%, P = 0.17). Moreover, there were no differences in bleeding rates according to the cessation or continuance of antithrombotic drugs (20 vs. 25%, P = 0.74). There were no thromboembolisms in all cases.
  
  
  
  Upper gastrointestinal endoscopic procedures performed under the new guidelines appear acceptable. However, endoscopic procedures among multiple antithrombotic drug users show a greater potential for bleeding.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. hxnwq178@yahoo.co.jp.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Kono
authors.affiliation: Department of Internal Medicine, Sumitomo Bessi Hospital, Niihama, 792-8543, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsubara
authors.affiliation: Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Fukuyama, 720-8520, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Toyokawa
authors.affiliation: Department of Gastroenterology, Tsuyama Chuo Hospital, Tsuyama, 708-0841, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Takenaka
authors.affiliation: Department of Internal Medicine, Sumitomo Bessi Hospital, Niihama, 792-8543, Japan.
authors.forename: Seiyu
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, 700-8551, Japan.
authors.forename: Junichirou
authors.initials: J
authors.lastname: Nasu
authors.affiliation: Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, 700-8551, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Yoshioka
authors.affiliation: Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, 730-8518, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, 730-8518, Japan.|Department of Internal Medicine, Kurashiki Central Hospital, Kurashiki, 710-8602, Japan.
authors.forename: Motowo
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakae
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Abe
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Gotoda
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Ko
authors.initials: K
authors.lastname: Miura
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kanzaki
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Iwamuro
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hori
authors.affiliation: Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, 670-8540, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Tsuzuki
authors.affiliation: Department of Internal Medicine, Okayama City Hospital, Okayama, 700-0833, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Kita
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawano
authors.affiliation: Department of Endoscopy, Okayama University Hospital, Okayama, 700-8558, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kawahara
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D016481:Helicobacter Infections / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020379:Risk Adjustment; D013923:Thromboembolism / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents
keywords: Antithrombotic drug; Endoscopy; Guidelines; Hemorrhage; Thromboembolism