AI Article Synopsis
- The study evaluated the risk factors and drug differences associated with post-endoscopic submucosal dissection (ESD) bleeding in patients using antithrombotic drugs, specifically direct oral anticoagulants (DOACs).
- Out of 278 patients, those on DOACs experienced a 19.6% incidence of post-ESD bleeding, with risk factors including larger resection size and presence of neutrophil infiltration.
- The findings suggest that DOACs elevate bleeding risk, particularly noting lower bleeding rates with the drug dabigatran compared to others like apixaban, edoxaban, and rivaroxaban.
Article Abstract
Objectives: Bleeding after endoscopic submucosal dissection (ESD) for gastric tumors in patients taking antithrombotic drugs, in particular direct oral anticoagulants (DOACs), remains unresolved; therefore, we evaluated the risk factors for post-ESD bleeding and drug differences in patients taking DOACs.
Methods: We included 278 patients taking antithrombotic drugs who underwent gastric ESD between January 2017 and March 2022. Antithrombotic drugs were withdrawn following the 2017 guidelines (Appendix on anticoagulants including DOACs). To further clarify differences in antithrombotic agents' effects, the peri-cancerous mucosa in the resected specimen was pathologically evaluated according to the Updated Sydney System. Multivariate analysis was performed to assess the risk of post-ESD bleeding.
Results: The incidence of post-ESD bleeding in patients taking DOACs was 19.6% (10/51). Among patients taking antithrombotic drugs, DOACs were identified as a possible factor involved in post-ESD bleeding (odds ratio [OR] 4.92). Among patients taking DOACs, possible factors included resection length diameter ≥30 mm (OR 3.72), presence of neutrophil infiltration (OR 2.71), lesions occurring in the lower third of stomach (OR 2.34), and preoperative antiplatelet use (OR 2.22). Post-ESD bleeding by DOAC type was 25.0% of patients (4/16) receiving apixaban, in 20.0% (3/15) receiving edoxaban, in 21.4% (3/14) receiving rivaroxaban, and in none of those receiving dabigatran.
Conclusions: The administration of DOACs was shown to be a possible factor involved in post-ESD bleeding, and risk factors for patients taking DOACs included neutrophil infiltration. The pharmacological differences in the effects of DOACs contributing to bleeding in gastric ulcers suggest comparatively less bleeding with dabigatran after ESD.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/den.14806 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Risk factor analysis and predictive model construction for postoperative bleeding in early esophageal cancer.
Am J Transl Res
October 2024
Department of Gastroenterology, Jiujiang City Key Laboratory of Cell Therapy, Jiujiang No. 1 People's Hospital Jiujiang 332000, Jiangxi, China.
Article Synopsis
- A multivariate logistic regression model was created to identify risk factors for postoperative bleeding in patients who underwent endoscopic submucosal dissection (ESD) for early esophageal cancer, analyzing data from 258 patients.
- The study found that factors such as history of hypertension, lesion diameter, submucosal fibrosis, C-reactive protein (CRP), and albumin (ALB) significantly increased the risk of bleeding, with an observed bleeding incidence of 12.02%.
- The nomogram developed from this research demonstrated strong predictive ability, with an area under the curve (AUC) of 0.821 for the training set and 0.740 for the validation set, indicating good fit between actual and predicted values.
Closure of gastric mucosal defects using the reopenable-clip over the line method to decrease the risk of bleeding after endoscopic submucosal dissection: a multicenter propensity score-matched case-control study (with video).
Gastrointest Endosc
November 2024
Department of Gastroenterology and Hepatology, Mie University Hospital, Japan.
Background And Aims: Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer. However, post-ESD bleeding presents significant risks. Closing mucosal defects following ESD may reduce the incidence of post-ESD bleeding.
View Article and Find Full Text PDFEndoscopic suturing for mucosal defect closure following endoscopic submucosal dissection: Systematic review and meta-analysis.
Endosc Int Open
October 2024
Internal Medicine, Rochester General Hospital, Rochester, United States.
Article Synopsis
- Endoscopic submucosal dissection (ESD) is a minimally invasive method for treating gastrointestinal lesions, but it has risks like bleeding and perforation.
- This meta-analysis assessed the safety and effectiveness of endoscopic suturing for closing defects after ESD by reviewing 426 publications and including data from 10 studies with 284 patients.
- Results showed a high technical success rate of 92.6% for endoscopic suturing, an 80.7% rate for sustained closure of defects, and a low incidence of complications, suggesting that endoscopic suturing is a promising approach post-ESD, though more extensive research is needed.
Clinical utility of a novel anchor pronged clip for mucosal defect closure after colorectal endoscopic submucosal dissection (with video).
Endosc Int Open
October 2024
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Koto-ku, Japan.
Article Synopsis
- The MANTIS Clip is a new medical device designed to improve tissue grasping and close defects in the gastrointestinal tract, specifically after colorectal endoscopic submucosal dissection (C-ESD).
- A study at a single center from May 2023 to April 2024 involved 52 patients, showing a very high complete closure success rate of 98.1% and a sustained closure rate of 96.1% for mucosal defects.
- The procedure had minimal complications, with only one instance each of bleeding and coagulation syndrome, indicating the MANTIS Clip's effectiveness and practicality, but further multicenter trials are recommended for more comprehensive evaluation.
A novel reopenable clip with sharp claw for complete closure of mucosal defects after colorectal endoscopic submucosal dissection.
Endoscopy
November 2024
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Background: The MANTIS Closure Device (MCD; Boston Scientific, Marlborough, Massachusetts, USA) is a reopenable clip with a sharp claw used for closure after endoscopic submucosal dissection (ESD). We evaluated the effectiveness of the MCD for fast and complete closure after colorectal ESD.
Methods: Cases involving closure with the MCD after ESD of 20-60-mm colorectal lesions between April 2023 and January 2024 were reviewed.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!