Risk of bleeding after endoscopic submucosal dissection for colorectal tumors in patients with continued use of low-dose aspirin

• Published in: Journal of gastroenterology Vol. 50; no. 10; pp. 1041 - 1046
• Main Authors: Ninomiya, Yuki, Oka, Shiro, Tanaka, Shinji, Nishiyama, Soki, Tamaru, Yuzuru, Asayama, Naoki, Shigita, Kenjiro, Hayashi, Nana, Chayama, Kazuaki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.10.2015; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Aspirin; Aspirin - administration & dosage; Aspirin - adverse effects; Care and treatment; Colonoscopy - methods; Colorectal cancer; Colorectal Neoplasms - surgery; Colorectal Surgery; Dissection - methods; Dosage and administration; Dose-Response Relationship, Drug; Endoscopy; Female; Follow-Up Studies; Gastroenterology; Gastrointestinal diseases; Gastrointestinal Hemorrhage - chemically induced; Gastrointestinal Hemorrhage - epidemiology; Hepatology; Hospital patients; Humans; Intestinal Mucosa - pathology; Intestinal Mucosa - surgery; Japan - epidemiology; Male; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Original Article—Alimentary Tract; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Postoperative Hemorrhage - chemically induced; Postoperative Hemorrhage - epidemiology; Prevalence; Retrospective Studies; Risk factors; Surgery; Surgical Oncology; Time Factors; Tumors; Japan; Complication; Colorectal tumor; Low-dose aspirin; Bleeding; ESD
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-015-1053-4

Background Although Japanese guidelines proposed by the Japan Gastroenterological Endoscopy Society for endoscopic submucosal dissection (ESD) for colorectal tumors recommend continued use of low-dose aspirin (LDA), this strategy is controversial. It was our practice to interrupt LDA therapy 5–7 days before ESD until December 2010, when we instituted the new guidelines and performed ESD without interrupting LDA therapy. The aim of the present study was to confirm the validity of the noninterrupted use of LDA inpatients undergoing ESD for colorectal tumors. Methods We studied 582 consecutive patients with 609 colorectal tumors who underwent ESD at Hiroshima University Hospital between January 2006 and July 2014. The patients comprised three groups: LDA-interrupted group (13 patients with 13 colorectal tumors), LDA-continued group (28 patients with 31 colorectal tumors), and no anticoagulant/antiplatelet group (541 patients with 565 colorectal tumors). Results The en bloc resection rate was 100 % (13/13) in the LDA-interrupted group and 90.3 % (28/31) in the LDA-continued group. Incidences of poor bleeding control during the procedure and bleeding after the procedure were 7.7 % (1/13) and 15.4 % (2/13) of patients, respectively, in the LDA-interrupted group, and 3.2 % (1/31) and 16.1 % (5/31) of patients, respectively, in the LDA-continued group. No patients experienced ischemic events in the perioperative period. Conclusions Our data suggest that continued use of LDA increased the risk of bleeding after ESD for colorectal tumors compared with nonuse of anticoagulant/antiplatelets. No significant difference was seen between the LDA-continued group and the LDA-interrupted group.