Is the Reinitiation of Antiplatelet Agents Safe at 1 Week after Gastric Endoscopic Submucosal Dissection? Assessment of Bleeding Risk Using the Forrest Classification
Gut and Liver
; : 489-496, 2017.
Article
in En
| WPRIM
| ID: wpr-88948
Responsible library:
WPRO
ABSTRACT
BACKGROUND/AIMS: Delayed bleeding after gastric endoscopic submucosal dissection (ESD) commonly occurs within 3 days, but it may also occur after 1 week following ESD, especially in antiplatelet agent users. We evaluated the risk of delayed bleeding in post-ESD ulcers using the Forrest classification. METHODS: Registry data on the Forrest classification of post-ESD ulcers (n=371) at 1 week or 2 weeks after ESD were retrospectively evaluated. The Forrest classification was categorized into two groups: increased risk (Forrest Ia to IIc) or low risk (Forrest III). The odds ratios (ORs) were calculated using logistic regression analysis. RESULTS: Among 371 post-ESD ulcers, one ulcer (0.3%) was classified as Forrest Ib, two (0.5%) as Forrest IIa, 17 (4.6%) as Forrest IIb, 172 (46.4%) as Forrest IIc, and 179 (48.2%) as Forrest III. The proportion of increased-risk ulcers was 72.2% (140/194) at 1 week after ESD, which decreased to 29.4% (52/177) at 2 weeks after ESD (p<0.001). In the multivariate analysis, a post-ESD ulcer at 1 week after ESD (OR, 7.54), younger age (OR, 2.17), and upper/middle ulcer location (OR, 2.05) were associated with increased-risk ulcers. CONCLUSIONS: One week after ESD, ulcers still have an increased risk of bleeding when assessed using the Forrest classification. This risk should be considered when resuming antiplatelet therapy.
Key words
Full text:
1
Database:
WPRIM
Main subject:
Stomach Neoplasms
/
Ulcer
/
Platelet Aggregation Inhibitors
/
Logistic Models
/
Odds Ratio
/
Multivariate Analysis
/
Retrospective Studies
/
Classification
/
Hemorrhage
Type of study:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Language:
En
Journal:
Gut and Liver
Year:
2017
Document type:
Article