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Device-assisted Enteroscopy for Obscure Gastrointestinal Bleeding in the Setting of Thienopyridine Antiplatelet
Elizabeth E Bollinger1, Melissa A Spera, Daniel L Raines
1Louisiana State University Health Sciences Center, New Orleans, LA.
Insights
Device-assisted enteroscopy (DAE) with endoscopic therapy is safe for patients on thienopyridine therapy. Continuing this antiplatelet medication may improve the diagnostic yield of DAE procedures for small bowel bleeding.
Area of Science:
- Gastroenterology
- Cardiology
Background:
- Current guidelines suggest stopping thienopyridine therapy before endoscopy to prevent bleeding.
- However, this interruption increases cardiovascular event risk.
- This study evaluates DAE safety and diagnostic yield in patients on thienopyridines.
Purpose of the Study:
- To assess the safety of device-assisted enteroscopy (DAE) with endoscopic interventions in patients continuing thienopyridine therapy.
- To determine the diagnostic yield of DAE in this patient group.
- To compare outcomes with current guidelines recommending therapy suspension.
Main Methods:
- Retrospective chart review of 774 enteroscopy procedures (October 2007 - February 2015).
- Identified 68 patients undergoing DAE while on active thienopyridine therapy.
- Reviewed procedural indications, interventions, and complications.
Main Results:
- 68 patients on thienopyridines underwent DAE, most for small bowel bleeding.
- 143 endoscopic interventions were performed, mainly argon plasma coagulation for angioectasias.
- No significant bleeding complications occurred; diagnostic yield was 77%.
Conclusions:
- DAE with endoscopic interventions appears safe for patients on thienopyridine therapy.
- Continuing thienopyridines may enhance diagnostic yield by facilitating visualization of active bleeding sources.
- Findings challenge the routine suspension of thienopyridines before DAE.
Background:
Current guidelines recommend suspending thienopyridine therapy 5 to 7 days before therapeutic endoscopy to reduce the risk of bleeding-related complication. However, interruption of antiplatelet therapy may increase the risk of a cardiovascular event. The aim of this study was to evaluate the safety and diagnostic yield of device-assisted enteroscopy (DAE) with endoscopic therapy in patients receiving thienopyridine antiplatelet therapy.
Materials And Methods:
A retrospective chart review was performed for patients treated in the LSU Health Sciences Gastroenterology Clinics between the dates of October 4, 2007 and February 15, 2015. A total of 774 enteroscopy procedures were reviewed to identify patients on active thienopyridine therapy at the time of DAE.
Results:
During the study period, a total of 68 patients underwent DAE while on thienopyridine therapy. Confirmed or suspected small bowel bleeding was the most common procedural indication. A total of 143 endoscopic interventions were performed, primarily argon plasma coagulation for ablation of intestinal angioectasias. There were no significant bleeding-related complications associated with these procedures. In addition, the diagnostic yield for these procedures was high (77%) with a significant percentage of patients in the thienopyridine group found to have an active bleeding source at the time of DAE.
Conclusions:
The performance of DAE procedures with endoscopic intervention such as argon plasma coagulation may be safe in patients on thienopyridine therapy. Continuing thienopyridines may also increase the diagnostic yield of these procedures by promoting active bleeding from the culprit source.
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