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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2016; 8(20): 756-762
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.756
Clinical problems with antithrombotic therapy for endoscopic submucosal dissection for gastric neoplasms
Toshiyuki Yoshio, Tsutomu Nishida, Yoshito Hayashi, Hideki Iijima, Masahiko Tsujii, Junko Fujisaki, Tetsuo Takehara
Toshiyuki Yoshio, Junko Fujisaki, Department of Gastroenterology, Cancer Institute Hospital, Tokyo 135-8550, Japan
Toshiyuki Yoshio, Department of Gastroenterology, Osaka National Hospital, National Hospital Organization, Osaka 560-8565, Japan
Tsutomu Nishida, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
Yoshito Hayashi, Hideki Iijima, Masahiko Tsujii, Tetsuo Takehara, Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka 560-8565, Japan
Masahiko Tsujii, Department of Gastroenterology, Higashiosaka City General Hospital, Osaka 560-8565, Japan
Author contributions: Yoshio T contributed to the conception, collected materials and wrote the manuscript; Nishida T contributed to the conception and supervised; Hayashi Y, Iijima H, Tsujii M, Fujisaki J and Takehara T made critical revisions related to important intellectual content of the manuscript.
Conflict-of-interest statement: The authors reported no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tsutomu Nishida, MD, PhD, Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka 560-8565, Japan. tnishida.gastro@gmail.com
Telephone: +81-6-68430101 Fax: +81-6-68583531
Received: June 6, 2016
Peer-review started: June 11, 2016
First decision: July 20, 2016
Revised: August 12, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: December 16, 2016
Core Tip

Core tip: It is unclear if antithrombotic therapy increases delayed bleeding after endoscopic submucosal dissection (ESD) of gastric neoplasms. With appropriate cessation, antithrombotic therapy does not increase delayed bleeding in low thrombosis-risk patients. However, high thrombosis-risk patients are often treated with combination therapy with antithrombotic agents, such as dual antiplatelet therapy (DAPT), and occasionally require the continuation of antithrombotic agents or heparin bridge therapy (HBT) in the perioperative period. Both patients with DAPT and HBT have a high risk of delayed bleeding. The management of these antithrombotic therapies is important in the perioperative period of ESD.