Risk of Postoperative Bleeding in Esophageal Endoscopic Submucosal Dissection for Squamous Cell Carcinoma in Patients...

Postendoscopic submucosal dissection (ESD) bleeding remains a critical concern in patients receiving antithrombotic therapy, yet the risk after esophageal ESD is poorly characterized. This multicenter retrospective study evaluated the incidence of post-ESD bleeding and thromboembolism in patients undergoing esophageal ESD while receiving antiplatelet therapy.

We analyzed 570 patients with esophageal squamous cell carcinoma treated with ESD while on antiplatelet therapy between 2017 and 2022 at 21 institutions in Japan. Patients were categorized into guideline-based discontinuation or continuation, excluding guideline-deviating discontinuation. The primary endpoint was the rate of post-ESD bleeding among thienopyridine users (monotherapy or dual antiplatelet therapy; DAPT) managed with guideline-based discontinuation. Secondary endpoints included bleeding rates according to antiplatelet regimen and thromboembolism incidence.

A total of 154, 41, and 375 patients received thienopyridine monotherapy, DAPT, and aspirin monotherapy, respectively. Antiplatelet therapy was continued perioperatively in 32.5%, 31.7%, and 73.1% of these groups. Post-ESD bleeding rates were 2.3% (3/132) and 3.2% (2/63) for guideline-based discontinuation and continuation of thienopyridine users, respectively. Bleeding rates for discontinuation vs. continuation were 0% (0/101) vs. 0.7% (2/274) for aspirin monotherapy, 1.9% (2/104) vs. 4.0% (2/50) for thienopyridine monotherapy, and 3.6% (1/28) vs. 0% (0/13) for DAPT. Thromboembolism occurred in two patients, both receiving aspirin monotherapy.

A substantial number of patients underwent esophageal ESD while continuing antiplatelet therapy. These descriptive findings suggest a need for further evaluation of continued therapy in larger studies.