Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms

Gastrointest Endosc. 2013 Sep;78(3):476-83. doi: 10.1016/j.gie.2013.03.008. Epub 2013 Apr 25.


Background: The discontinuation of antithrombotic drugs is recommended during endoscopic submucosal dissection (ESD) for gastric neoplasms; however, controversy remains as to whether antithrombotic drugs are risk factors for postoperative bleeding.

Objective: To determine the risk factors for post-ESD bleeding.

Design: Single-institution, retrospective review.

Setting: University hospital.

Patients: From June 2000 to December 2010, we treated 1192 gastric neoplasms in 1032 consecutive patients.

Intervention: The ESD procedures were performed by using the standard techniques. Antithrombotic drug therapy was principally interrupted preoperatively and was restarted when hemostasis was confirmed by second-look endoscopy.

Main outcome measurements: Risk factors for postoperative bleeding after ESD (early, delayed, and overall [combined] occurrence of bleeding during the first 5 postoperative days or thereafter) were analyzed by using logistic regression analysis.

Results: Among 1166 ESD-induced ulcer lesions, overall postoperative bleeding was evident in 62 lesions (5.3%); early and delayed bleeding occurred in 30 and 32 lesions (2.6% and 2.7%), respectively. Based on a multivariate analysis, a specimen size of >40 mm was the sole independent risk factor for overall bleeding. Moreover, oral antithrombotic drug therapy was selected as independent risk factor for delayed but not early bleeding, according to the multivariate analysis. The delayed bleeding rate in patients who had a specimen size of >40 mm and who used antithrombotic drugs was 11.6%.

Limitations: Retrospective design and single-site data collection.

Conclusion: Interruption of antithrombotic drug therapy may be adequate for preventing early post-ESD bleeding; however, reinitiating antithrombotic drug therapy is a significant independent risk factor for delayed post-ESD bleeding.

Keywords: EGC; ESD; IT; JGCA; Japanese Gastric Cancer Association; NSAID; early gastric cancer; endoscopic submucosal dissection; insulation-tipped; nonsteroidal anti-inflammatory drug.

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Adenoma / pathology
  • Adenoma / surgery*
  • Aged
  • Dissection / adverse effects*
  • Female
  • Fibrinolytic Agents / adverse effects*
  • Gastric Mucosa / surgery
  • Humans
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology*
  • Retrospective Studies
  • Risk Factors
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery*
  • Time Factors


  • Fibrinolytic Agents