Endoscopic submucosal dissection in early gastric cancer in elderly patients and comorbid conditions

Table 2 Endoscopic submucosal dissection in patients treated with antithrombotic agents n (%)

Ref.	Patients n, lesions n	En-bloc resection,with R0, %	Perforation	Late bleeding	HR No., bleeding	Thrombogenic event
Ono et al[21]	471, 56	96.4/82.1	1 (1.8)	6 (10.7)	1, 3 (33)	0 (0)
Lim et al[24]	274, ND	NE	0 (0)	26 (12.6)2	NA	1 (0.5)3
Koh et al[26]	175, ND	NE	NE	17 (9.7)4	NA	0 (0)
Takeuchi et al[27]	90, 90	NE	NE	21 (23.3)5	12, 21 (57)	1 (1)
Yoshio et al[22]	24, 24	100/100	0 (0)	9 (38)6	9, 24 (38)	1 (4.2)

¹Forty-four low-risk patients stopped treatment with antithrombotic agents for 1 wk before and after endoscopic submucosal dissection (ESD). Three high-risk patients underwent intravenous heparin replacement during the cessation period;

²A total of 274 patients were treated with antiplatelet medication, 102 of whom discontinued the use of these drugs for 7 d or more before ESD, whereas the remaining patients continued use;

³One (1%) of the 102 patients who discontinued the use of antiplatelet medication developed an acute cerebral infarction;

⁴Antithrombotic drug therapy was principally interrupted preoperatively and restarted when hemostasis was confirmed by second-look endoscopy. The rate of early postoperative bleeding during the first 5 postoperative days was 4%, and the rate of subsequent bleeding was 5.7%;

⁵All patients commenced treatment with proton pump inhibitors immediately following surgery. Antiplatelet agents were discontinued for 7 d preoperatively until postoperative day 1, and anticoagulants were discontinued for 5 d preoperatively until postoperative day 1. A total of 46 patients received low-dose aspirin (LDA) only, 23 received LDA + thienopyridine, and 21 received LDA + warfarin. Anticoagulants were discontinued from preoperative day 4 to postoperative day 2. Heparin was substituted for anticoagulants after the latter were discontinued;

⁶All patients underwent intravenous heparin replacement during the cessation period because of an increased risk of thromboembolism. HR: Heparin replacement; NA: Not applicable; NE: Not evaluated.