Endoloop closure following gastric endoscopic submucosal dissection to prevent delayed bleeding in patients receiving antithrombotic therapy

Abstract Objectives Given the high risk of bleeding in post-endoscopic submucosal dissection (ESD) patients receiving antithrombotic therapy, a new effective method is needed to prevent delayed bleeding among such patients. The aim of this study was to assess the efficacy of endoloop closure, using an endoloop and clips, after gastric ESD to prevent bleeding among patients receiving antithrombotic therapy. Methods This retrospective study enrolled patients taking antithrombotic agents who underwent ESD for early gastric cancer between March 2016 and January 2019. Patients were classified into two groups: the endoloop closure group and the control group (no prophylactic treatment). We compared the rates of post-endoscopic submucosal dissection bleeding between the two groups. Results Overall, 178 patients were included, with 37 patients in the endoloop closure group and 141 patients in the control group. The rate of post-endoscopic submucosal dissection bleeding was in general lower in the endoloop closure group than in the control group; however, the difference was not statistically significant (8% vs. 23%, p = 0.06). Among patients with a resected specimen size <40 mm and those using multiple antithrombotic agents, the endoloop closure group showed a lower rate of post-endoscopic submucosal dissection bleeding (0% vs. 16%, p = 0.03 and 10% vs. 70%, p = 0.02, respectively). Conclusions Closure using an endoloop and endoclips after gastric ESD might prevent post-procedure bleeding in patients receiving antithrombotic therapy, particularly in those patients with a resected specimen <40 mm and those receiving multiple antithrombotic agents.

[1]  I. Oda,et al.  Endoscopic Closure Utilizing Endoloop and Endoclips After Gastric Endoscopic Submucosal Dissection for Patients on Antithrombotic Therapy , 2020, Digestive Diseases and Sciences.

[2]  A. Masamune,et al.  Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score , 2020, Gut.

[3]  H. Ono,et al.  Endoscopic hand-suturing is feasible, safe, and might contribute in reducing bleeding risk after gastric endoscopic submucosal dissection: a multicenter pilot study (with video). , 2020, Gastrointestinal endoscopy.

[4]  N. Yamamichi,et al.  Endoscopic tissue shielding to prevent bleeding after endoscopic submucosal dissection: a prospective multicenter randomized controlled trial , 2019, Endoscopy.

[5]  T. Yano,et al.  Short‐term outcomes of multicenter prospective cohort study of gastric endoscopic resection: ‘Real‐world evidence’ in Japan , 2018, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[6]  N. Uedo,et al.  Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment: 2017 Appendix on Anticoagulants Including Direct Oral Anticoagulants , 2018, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[7]  D. Kikuchi,et al.  Feasibility of Autologous Fibrin Glue and Polyglycolic Acid Sheets to Prevent Delayed Bleeding after Endoscopic Submucosal Dissection of Gastric Neoplasms in Patients Receiving Antithrombotic Therapy , 2018, Gastroenterology research and practice.

[8]  H. Ono,et al.  Efficacy of polyglycolic acid sheets and fibrin glue for prevention of bleeding after gastric endoscopic submucosal dissection in patients under continued antithrombotic agents , 2018, Gastric Cancer.

[9]  K. Hirasawa,et al.  Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection , 2017, World journal of gastroenterology.

[10]  H. Ono,et al.  Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection? , 2017, Surgical Endoscopy.

[11]  K. Yao,et al.  Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer , 2016, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[12]  N. Yamamichi,et al.  Polyglycolic acid sheets and fibrin glue decrease the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms (with video). , 2015, Gastrointestinal endoscopy.

[13]  K. Koike,et al.  Thienopyridine derivatives as risk factors for bleeding following high risk endoscopic treatments: Safe Treatment on Antiplatelets (STRAP) study , 2015, Endoscopy.

[14]  G. W. Lua,et al.  Closure of a large mucosal defect after endoscopic submucosal dissection using “pre-detached loop and clips” method with a single-channel gastroscope , 2015, Endoscopy.

[15]  I. Oda,et al.  Complete endoscopic closure of a large gastric defect with endoloop and endoclips after complex endoscopic submucosal dissection , 2015, Endoscopy.

[16]  S. Tounou,et al.  Continuous aspirin use does not increase post-endoscopic dissection bleeding risk for gastric neoplasms in patients on antiplatelet therapy , 2014, Endoscopy International Open.

[17]  Masaru Harada,et al.  Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of a single over-the-scope clip and through-the-scope clips (with videos) , 2014, Surgical Endoscopy.

[18]  Sergey V Kantsevoy,et al.  Endoscopic suturing closure of large mucosal defects after endoscopic submucosal dissection is technically feasible, fast, and eliminates the need for hospitalization (with videos). , 2014, Gastrointestinal endoscopy.

[19]  T. Matsui,et al.  Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment , 2014, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[20]  Takuya Yamada,et al.  Gastric ESD under Heparin Replacement at High-Risk Patients of Thromboembolism Is Technically Feasible but Has a High Risk of Delayed Bleeding: Osaka University ESD Study Group , 2013, Gastroenterology research and practice.

[21]  Ichiro Oda,et al.  Complications of Gastric Endoscopic Submucosal Dissection , 2013, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[22]  Y. Kanda,et al.  Investigation of the freely available easy-to-use software ‘EZR' for medical statistics , 2012, Bone Marrow Transplantation.

[23]  Ji Won Kim,et al.  Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms? , 2012, Gastrointestinal endoscopy.

[24]  N. Yamamichi,et al.  PROSPECTIVE SINGLE‐ARM TRIAL OF TWO‐WEEK RABEPRAZOLE TREATMENT FOR ULCER HEALING AFTER GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION , 2012, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[25]  I. Choi,et al.  Aspirin use and bleeding risk after endoscopic submucosal dissection in patients with gastric neoplasms , 2012, Endoscopy.

[26]  H. Chae,et al.  Routine Mucosal Closure with a Detachable Snare and Clips after Endoscopic Submucosal Dissection for Gastric Epithelial Neoplasms: A Randomized Controlled Trial , 2011, Gut and liver.

[27]  H. Ono,et al.  Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer , 2008, Gastric Cancer.

[28]  H. Ono,et al.  Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection--an analysis of risk factors. , 2008, Endoscopy.

[29]  G. Lee,et al.  Application of metal hemoclips for closure of endoscopic mucosal resection–induced ulcers of the stomach to prevent delayed bleeding , 2008, Surgical Endoscopy.

[30]  Hiroaki Ikematsu,et al.  Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. , 2004, Gastrointestinal endoscopy.