Postoperative Bleeding Risk after Gastric Endoscopic Submucosal Dissection in Patients Receiving a P2Y12 Receptor...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Cardiology (Antiplatelet Therapy)

Background:

• The safety of gastric endoscopic submucosal dissection (ESD) in patients using P2Y12 receptor antagonists (P2Y12RA) remains unverified under current guidelines.
• Postoperative bleeding is a significant concern following ESD procedures.

Purpose of the Study:

• To evaluate the safety and postoperative bleeding rates associated with gastric ESD in patients using P2Y12 receptor antagonists (P2Y12RA).
• To identify risk factors for post-ESD bleeding, including antithrombotic drug management.

Main Methods:

• A retrospective analysis of 1,036 gastric ESD procedures performed between January 2013 and December 2020.
• Patients were categorized into three groups: no antithrombotics, aspirin/cilostazol monotherapy, and P2Y12RA users (monotherapy or dual therapy).
• Postoperative bleeding rates were compared, and risk factors were assessed using multivariate analysis.

Main Results:

• Bleeding rates were significantly higher in patients on antithrombotic drugs (Groups B and C) compared to those not receiving them (Group A).
• No significant difference in bleeding rates was observed between aspirin/cilostazol monotherapy and P2Y12RA users.
• Dual antiplatelet therapy showed a significantly higher bleeding rate than P2Y12RA monotherapy. Tumor diameter ≥12 mm, anticoagulant use, and P2Y12RA use were identified as significant risk factors.

Conclusions:

• P2Y12 receptor antagonist (P2Y12RA) use is an independent risk factor for postoperative bleeding after gastric ESD, even when managed according to guidelines.
• Dual antiplatelet therapy presents a higher bleeding risk than P2Y12RA monotherapy in the context of gastric ESD.