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Current evidence and issues of endoscopic submucosal dissection for gastric neoplasms during antithrombotic therapy

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Abstract

Endoscopic submucosal dissection (ESD) for gastric neoplasms is a useful treatment globally. However, postoperative bleeding after gastric ESD is a serious, and sometimes life-threatening complication in patients receiving antithrombotic drugs, because antithrombotic drugs are considered to increase the risk of postoperative bleeding after gastric ESD. In contrast, withdrawal of antithrombotic drugs during the perioperative period increases the risk of thrombotic complications. Guidelines for the management of antithrombotic drugs during the periendoscopic period have been published by different countries, and recent guidelines place greater emphasis on the risk of thromboembolism with the discontinuation of antithrombotic drugs than on the risk of bleeding with the continuation of antithrombotic drugs. Several studies have reported on the validity of these guidelines, and clinical evidence is being established. Most studies reported that gastric ESD under continuation of aspirin or cilostazol did not increase the risk of bleeding, whereas heparin replacement was strongly associated with a higher risk of bleeding. However, the data regarding some clinical issues about the management of antithrombotic drugs, such as the safety of gastric ESD under continuation of thienopyridine, administration of multiple antithrombotic drugs including dual antiplatelet and anticoagulants (warfarin and direct oral anticoagulant), and effective prophylactic methods for postoperative bleeding after gastric ESD are lacking. Larger clinical data are needed to resolve the remaining issues in the future.

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Authors and Affiliations

  1. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan

    Yoshiyasu Kono, Issei Hirata, Tetsuya Katayama, Hisahiro Uemura, Tetsu Hirata, Tatsuhiro Gotoda, Koji Miyahara & Yuki Moritou

  2. Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan

    Masahiro Nakagawa

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  1. Yoshiyasu Kono
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  2. Issei Hirata
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Contributions

KY: conception and design of the work and drafting the manuscript. HI, KT, UH, HT, GT, MK, and MY: acquisition, analysis, or interpretation of data for the work. NM: revising it critically for important intellectual content and final approval of the version to be published.

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Correspondence to Yoshiyasu Kono.

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Yoshiyasu Kono, Issei Hirata, Tetsuya Katayama, Hisahiro Uemura, Tetsu Hirata, Tatsuhiro Gotoda, Koji Miyahara, Yuki Moritou and Masahiro Nakagawa declare that they have no conflict of interest

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Kono, Y., Hirata, I., Katayama, T. et al. Current evidence and issues of endoscopic submucosal dissection for gastric neoplasms during antithrombotic therapy. Clin J Gastroenterol 13, 650–659 (2020). https://doi.org/10.1007/s12328-020-01171-y

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