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Endoscopic mucosal resection of early oesophageal neoplasia in patients requiring anticoagulation: is it safe?

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Abstract

Background and aim

Endoscopic mucosal resection (EMR) has become the standard treatment for early oesophageal neoplasia. The mucosal defect caused by EMR usually takes several weeks to heal. Despite guidelines on high-risk endoscopic procedures in patients on anticoagulation, evidence is lacking whether EMR is safe in such patients. We investigated the immediate and delayed bleeding risk in patients undergoing diagnostic or therapeutic oesophageal EMR comparing patients requiring warfarin anticoagulation with a control group.

Methods

Warfarin was stopped 5 days before the planned EMR and restarted on the evening following the procedure. Patients with high-risk conditions, such as recent pulmonary thromboemboli, received bridging with low molecular weight heparin. All EMRs were performed when the INR was <1.5. Bleeding events on the day of the EMR and within 3 months post-procedure were documented.

Results

One hundred and seventeen consecutive patients with early oesophageal neoplasia were included. Sixty-eight EMRs were performed in 15 patients requiring anticoagulation. One patient on warfarin was readmitted 10 days after EMR with haematemesis and melaena. Out of 400 EMRs in 102 controls, 26 immediate bleeding events occurred requiring endoscopic intervention. One delayed bleeding event (melaena) occurred in the control group. The number of bleeding events did not differ between groups [p = 0.99; odds ratio 1.01 (0.30–3.44)], neither for acute (p = 0.76) nor delayed bleeding (p = 0.24).

Conclusion

EMR of early oesophageal neoplasia can be safely performed in patients requiring anticoagulation when warfarin is discontinued 5 days before the endoscopic intervention and reinstituted on the evening of the procedure day.

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Authors and Affiliations

  1. Translational Gastroenterology Unit, Oxford University Hospitals, OX3 9DU, Oxford, UK

    Said Al-Mammari, Andreas Koutsoumpas, Adam A. Bailey & Barbara Braden

  2. Department of Upper GI Surgery, Oxford University Hospitals, Oxford, UK

    Richard Owen, John Findlay, Richard Gillies, Robert Marshall, Nick Maynard & Bruno Sgromo

Authors
  1. Said Al-Mammari
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  2. Richard Owen
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  3. John Findlay
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  4. Andreas Koutsoumpas
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  5. Richard Gillies
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  7. Adam A. Bailey
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  8. Nick Maynard
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  9. Bruno Sgromo
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  10. Barbara Braden
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Correspondence to Barbara Braden.

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Disclosures

Said Al-Mammari, Richard Owen, John Findlay, Andreas Koutsoumpas, Richard Gillies, Robert Marshall, Adam A. Bailey, Nick Maynard, Bruno Sgromo and Barbara Braden have no conflict of interest or financial ties to disclose.

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Al-Mammari, S., Owen, R., Findlay, J. et al. Endoscopic mucosal resection of early oesophageal neoplasia in patients requiring anticoagulation: is it safe?. Surg Endosc 30, 2390–2395 (2016). https://doi.org/10.1007/s00464-015-4489-y

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  • DOI: https://doi.org/10.1007/s00464-015-4489-y

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