[Eight cases of Percutaneous Endoscopic Gastrostomy (PEG) in patients taking oral anticoagulants]

Patients who undergo percutaneous endoscopic gastrostomy (PEG) placement are often on antiplatelet therapy. There is a potential risk of infarction if these medications are discontinued.The guidelines of the Japan Gastroenterological Endoscopy Society, classify PEG as an operation associated with a high risk of bleeding; however, it is known that surgery can be performed without interruption when patients are treated with low-dose aspirin alone. Nevertheless, we experienced the case of severe bleeding at the incision site, which was accompanied by massive hematemesis and hemorrhagic shock the night after PEG using the modified introducer method in an 87-year-old male patient. The patient was being treated with Bayer aspirin (100 mg/day, oral). The patient's platelet count, PT, and APTT were within the normal levels. Thus, we decided to investigate the pull method as the effective method for pressure hemostasis comparing with the modified introducer method, to reduce the risks associated with bleeding after surgery when patients are being treated with antiplatelet drugs.PEG was performed by the pull method on eight patients who were being treated with oral antiplatelet drugs (including four patients receiving dual antiplatelet therapy [DAPT]). All patients had previously suffered strokes, and they all presented with normal platelet counts, PT, and APTT values.Only slight bleeding was observed in one out of eight patients (bleeding had stopped by the following day using an alginate patch on the abdominal wall at the incision site, along with direct pressure using a stationary plate). None of the patients showed infection at the incision site.Although the study population was small, the present study showed that PEG using the pull method is safe while patients are being treated with oral antiplatelet drugs.