在使用氯吡格雷和阿司匹林的患者中使用冷套管切除技术切除小肠息肉的安全性：韩国肠道疾病研究协会的一项前瞻性多中心研究。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-04-01 DOI:10.1016/j.gie.2024.10.014

Tae-Geun Gweon MD, PhD , Hyun Gun Kim MD, PhD , Yunho Jung MD, PhD , Seong Ran Jeon MD, PhD , Soo-Young Na MD, PhD , Yoo Jin Lee MD, PhD , Tae Ho Kim MD, PhD

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引用次数: 0

摘要

背景：/目的：息肉切除术是一种出血风险较高的手术。指南建议在息肉切除术期间不间断使用阿司匹林，同时建议在息肉切除术前 5-7 天停止使用氯吡格雷。对于息肉切除术后出血，冷套管切除技术（无论是否进行粘膜下注射）被认为比使用电凝的传统息肉切除术更安全。在本研究中，我们旨在比较氯吡格雷和阿司匹林使用者在冷窦切除术中的出血并发症：这项多中心、前瞻性队列研究在韩国五家学术医院进行，包括接受息肉切除术的氯吡格雷和阿司匹林使用者。抗血小板药物的使用没有间断，间断≤3天定义为持续使用。主要终点是延迟出血，即息肉切除术后数小时发生的出血，而即刻出血是指息肉切除术后2分钟需要止血的出血。对每个息肉立即出血的风险因素进行了调查：在 263 名患者（氯吡格雷，129 人；阿司匹林，134 人）中，509 人接受了息肉切除术。氯吡格雷组和阿司匹林组每位患者的延迟出血率分别为0.8%和0.7%，符合非劣效性（比率差异为0.03% [95%置信区间：-2.07%至2.13%]）。100名接受息肉切除术的患者（19.8%）实现了止血。即刻出血风险因素包括女性、终末期肾病、切除前粘膜下注射以及息肉大小≥5毫米：这项多中心前瞻性研究表明，在接受氯吡格雷和阿司匹林不间断治疗（NCT04328987）的患者中，冷镜切除术是安全的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Safety of cold snare resection techniques for removal of polyps in the small colon in patients taking clopidogrel and aspirin: a Korean Association for the Study of Intestinal Diseases prospective multicenter study

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Background and Aims

Polypectomy is a procedure associated with a high risk of bleeding. Guidelines recommend uninterrupted aspirin use during polypectomy, whereas cessation of clopidogrel 5 to 7 days before polypectomy is recommended. The cold snare resection (CSR) technique, with or without submucosal injection, is considered safer than conventional polypectomy using electrocoagulation for postpolypectomy bleeding. In this study, we compared the bleeding adverse events associated with CSR between clopidogrel and aspirin users.

Methods

This multicenter prospective cohort study was conducted in 5 academic hospitals in Korea and included clopidogrel and aspirin users who underwent polypectomy. Antiplatelet agents were used without interruption, with ≤3 days of interruption defined as continuous use. The primary endpoint was delayed bleeding, which was defined as bleeding occurring several hours after polypectomy, whereas immediate bleeding was defined as bleeding requiring hemostasis 2 minutes after polypectomy. Risk factors for immediate bleeding were investigated for each polyp.

Results

Finally, 263 patients (509 polyps) were included, including those receiving clopidogrel (n=129) and aspirin (n=134). The rates of delayed bleeding per patient in the clopidogrel and aspirin groups were .8% and .7%, respectively, meeting noninferiority (rate difference, .03%; 95% confidence interval, –2.07 to 2.13). A total of 100 cases of hemostasis (19.8%) were performed in 68 patients after polypectomy. Immediate bleeding risk factors were female sex, end-stage renal disease, submucosal injection before resection, and polyp size ≥5 mm.

Conclusions

This multicenter prospective study demonstrated the safety of CSR in patients treated with uninterrupted clopidogrel and aspirin. (Clinical trial registration number: NCT04328987.)

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.