%0 Journal Article
%T 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
%A Toshiyuki Yoshio
%A Tsutomu Nishida
%A Naoki Kawai
%A Kiyonori Yuguchi
%A Takuya Yamada
%A Takamasa Yabuta
%A Masato Komori
%A Shinjiro Yamaguchi
%A Shinji Kitamura
%A Hideki Iijima
%A Shusaku Tsutsui
%A Tomoki Michida
%A Eiji Mita
%A Masahiko Tsujii
%A Tetsuo Takehara
%J Gastroenterology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/365830
%X Objectives. Heparin replacement (HR) is often performed in patients with a high risk of thrombosis undergoing endoscopic procedures. However, information about the influence of HR is scarce. The aim of this study is to assess the clinical impact of HR for gastric endoscopic submucosal dissection (ESD). Methods. This is a retrospective study comprising approximately 1310 consecutive gastric neoplasms in 1250 patients, who underwent ESD in 5 institutes. We assessed the clinical findings and outcomes of ESD under HR, compared to ESD without HR as control. Results. A total of 24 EGC lesions in 24 patients were treated by ESD under HR. In the HR group, the complete en-bloc resection rate was 100%. The delayed bleeding rate was, however, higher in the HR group than in the controls (38% versus 4.6%). The timing of bleeding in the HR group was significantly later than in controls. In the control group, 209 patients discontinued antithrombotic therapy during perioperative period, and their delayed bleeding rate was not different from those without antithrombotic therapy (5.7% versus. 4.4%). A thromboembolic event was encountered in 1 patient under HR after delayed bleeding. Conclusion. ESD under HR is technically feasible but has a high risk of delayed bleeding. 1. Introduction Endoscopic resection of early gastric cancer (EGC) started as endoscopic mucosal resection (EMR) [1] and has dramatically developed and been applied in many patients, owing to the establishment of criteria for node-negative tumors [2] and the advancements of endoscopic submucosal dissection (ESD) [3¨C6]. We recently reported, in a multicenter study, that ESD is a feasible method for treating EGC [7] and that long-term outcome of gastric ESD is satisfactory [8]. We also showed that almost all recurrent lesions, synchronous or metachronous, were treatable by endoscopic resection by scheduled endoscopic surveillance [8]. ESD has become a more acceptable option for EGC than gastrectomy in elderly patients, who often have several comorbidities [9] and accompanying medication such as antithrombogenic agents for the primary and secondary prevention of cerebrovascular and cardiovascular diseases. Some patients with comorbidities such as valvular heart disease, atrial fibrillation with history of cerebrovascular accident have a high risk of developing thrombotic disease. Discontinuation of antithrombotic agents in these patients may cause life-threatening cerebrovascular and cardiovascular events. Such patients are often treated under heparin replacement (HR) of antithrombotic drugs, as a bridge
%U http://www.hindawi.com/journals/grp/2013/365830/