Is the Reinitiation of Antiplatelet Agents Safe at 1 Week after Gastric Endoscopic Submucosal Dissection? Assessment of Bleeding Risk Using the Forrest Classification.
OBJECTIVE
Delayed bleeding after gastric endoscopic submucosal dissection (ESD) commonly occurs within 3 days, but it may also occur after 1 week following ESD, especially in antiplatelet agent users. We evaluated the risk of delayed bleeding in post-ESD ulcers using the Forrest classification.


METHODS
Registry data on the Forrest classification of post-ESD ulcers (n=371) at 1 week or 2 weeks after ESD were retrospectively evaluated. The Forrest classification was categorized into two groups: increased risk (Forrest Ia to IIc) or low risk (Forrest III). The odds ratios (ORs) were calculated using logistic regression analysis.


RESULTS
Among 371 post-ESD ulcers, one ulcer (0.3%) was classified as Forrest Ib, two (0.5%) as Forrest IIa, 17 (4.6%) as Forrest IIb, 172 (46.4%) as Forrest IIc, and 179 (48.2%) as Forrest III. The proportion of increased-risk ulcers was 72.2% (140/194) at 1 week after ESD, which decreased to 29.4% (52/177) at 2 weeks after ESD (p<0.001). In the multivariate analysis, a post-ESD ulcer at 1 week after ESD (OR, 7.54), younger age (OR, 2.17), and upper/middle ulcer location (OR, 2.05) were associated with increased-risk ulcers.


CONCLUSIONS
One week after ESD, ulcers still have an increased risk of bleeding when assessed using the Forrest classification. This risk should be considered when resuming antiplatelet therapy.
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Jong Yeul
JY
Lee
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Chan Gyoo
CG
Kim
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Soo-Jeong
SJ
Cho
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Young-Il
YI
Kim
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Il Ju
IJ
Choi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011184:Postoperative Period; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors
Endoscopic mucosal resection; Forrest classification; Hemorrhage; Stomach neoplasms