Journal
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY
Volume 56, Issue 9, Pages 1117-1125Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/00365521.2021.1949491
Keywords
Gastric cancer; endoscopic submucosal dissection; post-ESD bleeding; endoloop closure; antithrombotic therapy
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The study aims to evaluate the effectiveness of endoloop closure in preventing bleeding after gastric ESD in patients receiving antithrombotic therapy. Results showed that the endoloop closure group had a lower rate of bleeding compared to the control group, especially among patients with smaller resected specimen sizes and those using multiple antithrombotic agents.
Objectives Given the high risk of bleeding in post-endoscopic submucosal dissection (ESD) patients receiving antithrombotic therapy, a new effective method is needed to prevent delayed bleeding among such patients. The aim of this study was to assess the efficacy of endoloop closure, using an endoloop and clips, after gastric ESD to prevent bleeding among patients receiving antithrombotic therapy. Methods This retrospective study enrolled patients taking antithrombotic agents who underwent ESD for early gastric cancer between March 2016 and January 2019. Patients were classified into two groups: the endoloop closure group and the control group (no prophylactic treatment). We compared the rates of post-endoscopic submucosal dissection bleeding between the two groups. Results Overall, 178 patients were included, with 37 patients in the endoloop closure group and 141 patients in the control group. The rate of post-endoscopic submucosal dissection bleeding was in general lower in the endoloop closure group than in the control group; however, the difference was not statistically significant (8% vs. 23%, p = 0.06). Among patients with a resected specimen size <40 mm and those using multiple antithrombotic agents, the endoloop closure group showed a lower rate of post-endoscopic submucosal dissection bleeding (0% vs. 16%, p = 0.03 and 10% vs. 70%, p = 0.02, respectively). Conclusions Closure using an endoloop and endoclips after gastric ESD might prevent post-procedure bleeding in patients receiving antithrombotic therapy, particularly in those patients with a resected specimen <40 mm and those receiving multiple antithrombotic agents.
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