Risk of Postoperative Bleeding in Esophageal Endoscopic Submucosal Dissection for Squamous Cell Carcinoma in Patients on Antiplatelet Therapy: A Multicenter Retrospective Study in Japan

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy Pub Date : 2026-07-15 DOI:10.1111/den.70206

Ryosuke Hirai, Yoichi Yamamoto, Takeshi Yasuda, Takumi Yanagita, Taro Iwatsubo, Yasuhiro Tani, Shunsuke Yoshii, Yuhei Sakata, Hiroyoshi Iwagami, Takahito Nozaka, Takeshi Uozumi, Yuichi Masui, Jun Konishi, Kazuo Shiotsuki, Koyo Kido, Yuki Kano, Ken Ohata, Noriko Matsuura, Akira Dobashi, Yusuke Yoda, Saeko Kushida, Yoshinobu Yamamoto, Yuji Urabe, Toshiyuki Yoshio, Seiichiro Abe, Tomohiro Kadota, Kohei Takizawa, Tomonori Yano, Hiroyuki Ono

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引用次数: 0

Abstract

Objectives

Postendoscopic submucosal dissection (ESD) bleeding remains a critical concern in patients receiving antithrombotic therapy, yet the risk after esophageal ESD is poorly characterized. This multicenter retrospective study evaluated the incidence of post-ESD bleeding and thromboembolism in patients undergoing esophageal ESD while receiving antiplatelet therapy.

Methods

We analyzed 570 patients with esophageal squamous cell carcinoma treated with ESD while on antiplatelet therapy between 2017 and 2022 at 21 institutions in Japan. Patients were categorized into guideline-based discontinuation or continuation, excluding guideline-deviating discontinuation. The primary endpoint was the rate of post-ESD bleeding among thienopyridine users (monotherapy or dual antiplatelet therapy; DAPT) managed with guideline-based discontinuation. Secondary endpoints included bleeding rates according to antiplatelet regimen and thromboembolism incidence.

Results

A total of 154, 41, and 375 patients received thienopyridine monotherapy, DAPT, and aspirin monotherapy, respectively. Antiplatelet therapy was continued perioperatively in 32.5%, 31.7%, and 73.1% of these groups. Post-ESD bleeding rates were 2.3% (3/132) and 3.2% (2/63) for guideline-based discontinuation and continuation of thienopyridine users, respectively. Bleeding rates for discontinuation vs. continuation were 0% (0/101) vs. 0.7% (2/274) for aspirin monotherapy, 1.9% (2/104) vs. 4.0% (2/50) for thienopyridine monotherapy, and 3.6% (1/28) vs. 0% (0/13) for DAPT. Thromboembolism occurred in two patients, both receiving aspirin monotherapy.

Conclusions

A substantial number of patients underwent esophageal ESD while continuing antiplatelet therapy. These descriptive findings suggest a need for further evaluation of continued therapy in larger studies.

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日本一项多中心回顾性研究：食管内镜粘膜下剥离治疗鳞状细胞癌患者抗血小板治疗后出血的风险

目的：内镜后粘膜下剥离（ESD）出血仍然是接受抗血栓治疗患者的一个关键问题，但食管ESD后的风险尚未明确。这项多中心回顾性研究评估了食管ESD患者在接受抗血小板治疗时ESD后出血和血栓栓塞的发生率。方法：我们分析了2017年至2022年日本21家机构570例接受ESD治疗并同时接受抗血小板治疗的食管鳞状细胞癌患者。患者被分为基于指南的停药或继续停药，不包括偏离指南的停药。主要终点是噻吩吡啶使用者（单药或双重抗血小板治疗；DAPT）在指南基础上停药的esd后出血率。次要终点包括抗血小板方案的出血率和血栓栓塞发生率。结果：分别有154例、41例和375例患者接受噻吩吡啶单药治疗、DAPT治疗和阿司匹林单药治疗。32.5%、31.7%和73.1%的患者围手术期继续接受抗血小板治疗。基于指南停用噻苯吡啶和继续使用噻苯吡啶的esd后出血率分别为2.3%（3/132）和3.2%（2/63）。阿司匹林单药治疗的停药和继续治疗的出血率分别为0%（0/101）和0.7%(2/274)，噻吩吡啶单药治疗的出血率分别为1.9%（2/104）和4.0% (2/50)，DAPT治疗的出血率分别为3.6%（1/28）和0%（0/13）。2例患者发生血栓栓塞，均接受阿司匹林单药治疗。结论：大量患者在继续抗血小板治疗的同时发生了食管ESD。这些描述性的发现表明需要在更大规模的研究中进一步评估持续治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Endoscopy 医学-外科

CiteScore

10.10

自引率

15.10%

发文量

291

审稿时长

6-12 weeks

期刊介绍： Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.