Third-look endoscopy prevents delayed bleeding after endoscopic submucosal dissection under antithrombotic therapy.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Cardiovascular Medicine

Background:

• Postoperative delayed bleeding (PDB) is a significant risk following gastric endoscopic submucosal dissection (ESD), especially in patients using antithrombotics.
• The prevalence of antithrombotic use is increasing due to aging populations and associated comorbidities, highlighting the need for effective PDB prevention strategies.

Purpose of the Study:

• To evaluate the efficacy of third-look endoscopy (TLE) in preventing PDB after gastric ESD in patients receiving antithrombotics.

Main Methods:

• A prospective study involving 100 patients undergoing gastric ESD with TLE, analyzing PDB rates (overall, early-onset PDB [E-PDB], and late-onset PDB [L-PDB]).
• Comparison with a historical control group using propensity score matching to assess TLE's impact on PDB rates.
• Analysis of PDB rates stratified by antithrombotic agent use.

Main Results:

• The overall PDB rate was 7.9%, with L-PDB occurring at 5.3% and E-PDB at 2.6%.
• Propensity score matching revealed no significant difference in overall PDB (10.3% vs. 20.7%), but a significant reduction in L-PDB (5.2% vs. 17.2%) in the TLE group.
• TLE demonstrated a lower L-PDB incidence for direct oral anticoagulants and multiple antithrombotics compared to the control group.

Conclusions:

• Third-look endoscopy (TLE) is effective in reducing overall PDB after gastric ESD.
• TLE significantly lowers the incidence of late-onset PDB (L-PDB) in patients undergoing gastric ESD while on antithrombotic therapy.
• This strategy offers improved safety for patients on antithrombotics undergoing gastric ESD.