Timing of bleeding and thromboembolism associated with endoscopic submucosal dissection for gastric cancer in Japan.

Anticoagulants / adverse effects Aspirin / adverse effects Endoscopic Mucosal Resection / adverse effects Fibrinolytic Agents / adverse effects Gastric Mucosa Humans Japan / epidemiology Male Platelet Aggregation Inhibitors / adverse effects Postoperative Hemorrhage / epidemiology Renal Insufficiency, Chronic Retrospective Studies Risk Factors Stomach Neoplasms / surgery Thienopyridines Thromboembolism / epidemiology Warfarin / adverse effects
bleeding endoscopic submucosal dissection gastric cancer thromboembolism

Journal

Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909

Informations de publication

Date de publication:
Oct 2021
Historique:
revised: 18 04 2021
received: 19 02 2021
accepted: 25 04 2021
pubmed: 8 5 2021
medline: 11 2 2022
entrez: 7 5 2021
Statut: ppublish

Résumé

This study aimed to reveal the timing of bleeding and thromboembolism associated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We retrospectively reviewed  10,320 patients who underwent ESD for EGC during November 2013-October 2016. We evaluated overall bleeding rates and their inter-group differences. Factors associated with early/late (cut-off 5 days) bleeding and thromboembolism frequency and its association with the intake of antithrombotic agents were investigated. Overall, the post-ESD bleeding rate was 4.7% (489/10 320); the median time to post-ESD bleeding was 4 days. The post-ESD bleeding rates were 3.2%, 8.7%, 15.5%, and 29.9% in those not taking antithrombotic agents, those taking antiplatelet agents, those taking anticoagulants (ACs), and those taking antiplatelet agents and ACs. Warfarin (odds ratio [OR], 9.16), direct oral ACs (OR, 4.16), chronic kidney disease with hemodialysis (OR, 2.93), thienopyridine (OR, 2.25), aspirin (OR, 1.66), tumor size >30 mm (OR, 1.86), multiple tumors' resection (OR, 1.54), and tumor in the lower third of the stomach (OR, 1.40) were independent risk factors for early bleeding. The independent risk factors for late bleeding were direct oral ACs (OR, 7.42), chronic kidney disease with hemodialysis (OR, 4.99), warfarin (OR, 3.90), thienopyridine (OR, 3.09), liver cirrhosis (OR, 2.43), cilostazol (OR, 1.93), aspirin (OR, 1.92), ischemic heart disease (OR, 1.77), and male sex (OR, 1.65). There were three (0.03%) thromboembolic events (cerebral infarction = 2, transient ischemic attack = 1). We revealed the timing of bleeding and risk factors for early/late bleeding and showed the thromboembolism frequency associated with ESD for EGC.

Sections du résumé

BACKGROUND AND AIM OBJECTIVE
This study aimed to reveal the timing of bleeding and thromboembolism associated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).
METHODS METHODS
We retrospectively reviewed  10,320 patients who underwent ESD for EGC during November 2013-October 2016. We evaluated overall bleeding rates and their inter-group differences. Factors associated with early/late (cut-off 5 days) bleeding and thromboembolism frequency and its association with the intake of antithrombotic agents were investigated.
RESULTS RESULTS
Overall, the post-ESD bleeding rate was 4.7% (489/10 320); the median time to post-ESD bleeding was 4 days. The post-ESD bleeding rates were 3.2%, 8.7%, 15.5%, and 29.9% in those not taking antithrombotic agents, those taking antiplatelet agents, those taking anticoagulants (ACs), and those taking antiplatelet agents and ACs. Warfarin (odds ratio [OR], 9.16), direct oral ACs (OR, 4.16), chronic kidney disease with hemodialysis (OR, 2.93), thienopyridine (OR, 2.25), aspirin (OR, 1.66), tumor size >30 mm (OR, 1.86), multiple tumors' resection (OR, 1.54), and tumor in the lower third of the stomach (OR, 1.40) were independent risk factors for early bleeding. The independent risk factors for late bleeding were direct oral ACs (OR, 7.42), chronic kidney disease with hemodialysis (OR, 4.99), warfarin (OR, 3.90), thienopyridine (OR, 3.09), liver cirrhosis (OR, 2.43), cilostazol (OR, 1.93), aspirin (OR, 1.92), ischemic heart disease (OR, 1.77), and male sex (OR, 1.65). There were three (0.03%) thromboembolic events (cerebral infarction = 2, transient ischemic attack = 1).
CONCLUSION CONCLUSIONS
We revealed the timing of bleeding and risk factors for early/late bleeding and showed the thromboembolism frequency associated with ESD for EGC.

Identifiants

DOI: 10.1111/jgh.15536 PMID: 33960518
pubmed: 33960518
doi: 10.1111/jgh.15536
doi:

Substances chimiques

Anticoagulants 0
Fibrinolytic Agents 0
Platelet Aggregation Inhibitors 0
Thienopyridines 0
Warfarin 5Q7ZVV76EI
Aspirin R16CO5Y76E

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2769-2777

Informations de copyright

© 2021 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Références

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Auteurs

Sho Shiroma (S)

Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.
Department of Gastroenterology, Okinawa Kyodo Hospital, Naha, Japan.
ORCID: 0000-0001-7597-1790

Waku Hatta (W)

Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.

Yosuke Tsuji (Y)

Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

Toshiyuki Yoshio (T)

Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.
ORCID: 0000-0002-6546-0329

Yohei Yabuuchi (Y)

Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Japan.
ORCID: 0000-0003-0491-2579

Shu Hoteya (S)

Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.

Shigetsugu Tsuji (S)

Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.

Yasuaki Nagami (Y)

Department of Gastroenterology, Graduate School of Medicine, Osaka City University, Osaka, Japan.

Takuto Hikichi (T)

Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.

Masakuni Kobayashi (M)

Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan.

Yoshinori Morita (Y)

Department of Gastroenterology, Kobe University, International Clinical Cancer Research Center, Kobe, Japan.
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

Tetsuya Sumiyoshi (T)

Department of Gastroenterology, Tonan Hospital, Sapporo, Japan.

Mikitaka Iguchi (M)

Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.

Hideomi Tomida (H)

Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Department of Gastroenterology and Metabology, Graduate School of Medicine, Ehime University, Matsuyama, Japan.

Takuya Inoue (T)

Division of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan.
ORCID: 0000-0002-0365-3934

Tatsuya Mikami (T)

Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan.

Kenkei Hasatani (K)

Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan.

Jun Nishikawa (J)

Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.

Tomoaki Matsumura (T)

Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
ORCID: 0000-0001-5314-9325

Hiroko Nebiki (H)

Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan.

Dai Nakamatsu (D)

Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan.

Ken Ohnita (K)

Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.

Haruhisa Suzuki (H)

Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

Hiroya Ueyama (H)

Department of Gastroenterology, School of Medicine, Juntendo University, Tokyo, Japan.
ORCID: 0000-0002-5370-1009

Yoshito Hayashi (Y)

Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, Suita, Japan.

Mitsushige Sugimoto (M)

Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Kusatsu, Japan.
Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan.
ORCID: 0000-0002-9194-7392

Shinjiro Yamaguchi (S)

Department of Gastroenterology and Hepatology, Kansai Rosai Hospital, Amagasaki, Japan.

Tomoki Michida (T)

Department of Gastroenterology and Hepatology, Saitama Medical Center, Kawagoe, Japan.
Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

Tomoyuki Yada (T)

Division of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Tokyo, Japan.

Yoshiro Asahina (Y)

Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.

Toshiaki Narasaka (T)

Division of Endoscopic Center, University of Tsukuba Hospital, Tsukuba, Japan.

Shiko Kuribayashi (S)

Department of Gastroenterology and Hepatology, Graduate School of Medicine, Gunma University, Maebashi, Japan.
ORCID: 0000-0002-5067-552X

Shu Kiyotoki (S)

Department of Gastroenterology, Shuto General Hospital, Yanai, Japan.

Katsuhiro Mabe (K)

Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan.
Junpukai Health Maintenance Center Kurashiki, Okayama, Japan.

Mitsuhiro Fujishiro (M)

Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Atsushi Masamune (A)

Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.

Junko Fujisaki (J)

Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Composés chimiques organiques › Hydrocarbures › Hydrocarbures cycliques › Hydrocarbures aromatiques › Dérivés du benzène › Phénols › Hydroxybenzoates › Salicylates › Acide acétylsalicylique › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Endoscopie digestive › Endoscopie gastrointestinale › Mucosectomie endoscopique › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Fibrinolytiques › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Tissus › Membranes › Muqueuse › Muqueuse gastrique › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Régions géographiques › Iles › Japon › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Antiagrégants plaquettaires › Timing of bleeding and thromboembolism...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Hémorragie postopératoire › Timing of bleeding and thromboembolism...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie chronique › Insuffisance rénale chronique › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies de l'estomac › Tumeurs de l'estomac › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Composés hétérocycliques › Composés hétérocycliques à cycles fusionnés › Composés hétérobicycliques › Thiénopyridines › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Thromboembolie › Timing of bleeding and thromboembolism...
questionsmedicales.fr › Composés hétérocycliques › Composés hétérocycliques à cycles fusionnés › Composés hétérobicycliques › Benzopyranes › Coumarines › 4-Hydroxycoumarines › Warfarine › Timing of bleeding and thromboembolism...