Bleeding After Endoscopic Submucosal Dissection: The Role of Antithrombotic Drugs

Aims Bleeding is one of the most frequent complications of endoscopic submucosal dissection (ESD). Our aim is to evaluate the predictors of bleeding after ESD, namely the role of antithrombotic drugs, including anticoagulants and anti-platelet drugs.

Methods Retrospective cross-sectional study including all patients submitted to colorectal or gastro-oesophageal ESD between January 2018 and August 2020. The main outcome was the development of clinically significant bleeding during or after ESD, defined by the presence of visible blood loss, decrease in haemoglobin by >2 g/dL or the need for haemostatic treatment such as endoscopic clipping or haemostatic forceps.

Results A total of 72 ESD were analysed, 57 % were colorectal and 43 % were gastro-oesophageal. The en bloc resection rate and the complete resection rate were 90 % and 96 % respectively. Eight lesions were resected by hybrid technique. Bleeding secondary to ESD was reported in 22 % (n = 16) of the patients. Bleeding was more frequent in gastro-oesophageal ESD (69 %). Of all the patients who bled, 63 % were medicated with at least one antithrombotic drug, such as warfarin, direct oral anticoagulant, aspirin or P2Y12 inhibitors. The main reasons for anticoagulant and antiplatelet drugs use was the presence of atrial fibrillation (80 %) and primary prophylaxis of cardiovascular disease (73 %), respectively. The mean duration of hospitalization increased by 2 days in patients who suffered from bleeding (1 vs 3, p=0.04). The gastro-oesophageal location of the lesion (OR 3.96; 95 % CI 1.20-13.02; p=0.02) and the use of antithrombotic drugs (OR 4.56; 95 % CI 1.41-14.71; p=0.01) were significant predictors of the development of bleeding. There was no statistically significant association with the size of the lesion, duration of the ESD, age of the patient or use of hybrid technique.

Conclusions Patients submitted to gastro-oesophageal ESD or taking antithrombotic drugs are at increased risk of developing bleeding secondary to ESD.

Citation: Revés J Frias Gomes C, Nascimento C etal. eP281 BLEEDING AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION: THE ROLE OF ANTITHROMBOTIC DRUGS. Endoscopy 2021; 53: S190.

Publication History

Article published online:
19 March 2021