scholarly journals The Risk of Endoscopic Mucosal Resection in the Setting of Clopidogrel Use

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Vikneswaran Namasivayam ◽  
Ganapathy A. Prasad ◽  
Lori S. Lutzke ◽  
Kelly T. Dunagan ◽  
Lynn S. Borkenhagen ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Endoscopic Mucosal Resection ◽  
Average Risk ◽  
Limited Evidence ◽  
Single Centre ◽  
Mucosal Resection ◽  
Antiplatelet Medication ◽  
Increased Risk ◽  
Risk Patients ◽  
Ischemic Events

Objective. Guidelines on antiplatelet medication use during endoscopy are based on limited evidence. We investigate the risk of bleeding and ischemic events in patients undergoing endoscopic mucosal resection (EMR) of esophageal lesions in the setting of scheduled cessation and prompt resumption of clopidogrel. Design. Single centre retrospective review. Patients. Patients undergoing EMR of esophageal lesions. Interventions. Use of clopidogrel before EMR and resumption after EMR. Patients cease antiplatelets and anticoagulants 7 days before EMR and resume clopidogrel 2 days after EMR in average risk patients. Main Outcomes. Gastrointestinal bleeding (GIB) and ischemic events (IE) within 30 days of EMR. Results. 798 patients underwent 1716 EMR. 776 EMR were performed on patients on at least 1 antiplatelet/anticoagulant (APAC). 17 EMR were performed following clopidogrel cessation. There were 14 GIB and 2 IE. GIB risk in the setting of recent clopidogrel alone (0%) was comparable to those not on APAC (1.1%) (P=1.0). IE risk on clopidogrel (6.3%) was higher than those not on APAC (0.1%) (P=0.03). Limitations. Retrospective study. Conclusions. Temporary cessation of clopidogrel before EMR and prompt resumption is not associated with an increased risk of gastrointestinal bleeding but may be associated with increased ischemic events.

scholarly journals Colorectal endoscopic mucosal resection with submucosal injection of epinephrine versus hypertonic saline in patients taking antithrombotic agents: propensity-score-matching analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Daisuke Yamaguchi ◽  
Hisako Yoshida ◽  
Kei Ikeda ◽  
Yuki Takeuchi ◽  
Shota Yamashita ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Propensity Score Matching ◽  
Endoscopic Mucosal Resection ◽  
Hypertonic Saline ◽  
Colon Polyps ◽  
Antithrombotic Agents ◽  
Submucosal Injection ◽  
Mucosal Resection ◽  
Increased Risk

Abstract Background Endoscopic mucosal resection (EMR) to remove colon polyps is increasingly common in patients taking antithrombotic agents. The safety of EMR with submucosal saline injection has not been clearly demonstrated in this population. Aims The present study aimed to evaluate the efficacy and safety of submucosal injection of saline–epinephrine versus hypertonic saline in colorectal EMR of patients taking antithrombotic agents. Methods This study enrolled 204 patients taking antithrombotic agents among 995 consecutive patients who underwent colonic EMR from April 2012 to March 2018 at Ureshino Medical Center. Patients were divided into two groups according to the injected solution: saline–epinephrine or hypertonic (10%) saline (n = 102 in each group). Treatment outcomes and adverse events were evaluated in each group and risk factors for immediate and post-EMR bleeding were investigated. Results There were no differences between groups in patient or polyp characteristics. The main antithrombotic agents were low-dose aspirin, warfarin, and clopidogrel. Propensity-score matching created 80 matched pairs. Adjusted comparisons between groups showed similar en bloc resection rates (95.1% with saline–epinephrine vs. 98.0% with hypertonic saline). There were no significant differences in adverse events (immediate EMR bleeding, post-EMR bleeding, perforation, or mortality) between groups. Multivariate analyses revealed that polyp size over 10 mm was associated with an increased risk of immediate EMR bleeding (odds ratio 12.1, 95% confidence interval 2.0–74.0; P = 0.001). Conclusions Two tested solutions in colorectal EMR were considered to be both safe and effective in patients taking antithrombotic agents.

scholarly journals PTH-020 Endoscopic mucosal resection: evaluation of a single centre outcome

2018 ◽  
Author(s):  
Subashini Chandrapalan ◽  
Tracy Wood ◽  
James Crosbie ◽  
John Painter
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Single Centre ◽  
Mucosal Resection

scholarly journals High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack

2016 ◽  
Vol 6 (3) ◽  
pp. 76-83 ◽  
Author(s):  
Shawna Cutting ◽  
Elizabeth Regan ◽  
Vivien H. Lee ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Heart Association ◽  
Reperfusion Therapy ◽  
Large Artery ◽  
Increased Risk ◽  
Risk Patients ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
Ischemic Events

Background and Purpose: Following transient ischemic attack (TIA), there is increased risk for ischemic stroke. The American Heart Association recommends admission of patients with ABCD2 scores ≥3 for observation, rapid performance of diagnostic tests, and potential acute intervention. We aimed to determine if there is a relationship between ABCD2 scores, in-hospital ischemic events, and in-hospital treatments after TIA admission. Methods: We reviewed consecutive patients admitted between 2006 and 2011 following a TIA, defined as transient focal neurological symptoms attributed to a specific vascular distribution and lasting <24 h. Three interventions were prespecified: anticoagulation for atrial fibrillation, carotid or intracranial revascularization, and intravenous or intra-arterial reperfusion therapies. We compared rates of in-hospital recurrent TIA or ischemic stroke and the receipt of interventions among patients with low (<3) versus high (≥3) ABCD2 scores. Results: Of 249 patients, 11 patients (4.4%) had recurrent TIAs or strokes during their stay (8 TIAs, 3 strokes). All 11 had ABCD2 scores ≥3, and no neurological events occurred in patients with lower scores (5.1 vs. 0%; p = 0.37). Twelve patients (4.8%) underwent revascularization for large artery stenosis, 16 (6.4%) were started on anticoagulants, and no patient received intravenous or intra-arterial reperfusion therapy. The ABCD2 score was not associated with anticoagulation (p = 0.59) or revascularization (p = 0.20). Conclusions: Higher ABCD2 scores may predict early ischemic events after TIA but do not predict the need for intervention. Outpatient evaluation for those with scores <3 would potentially have delayed revascularization or anticoagulant treatment in nearly one-fifth of ‘low-risk' patients.

scholarly journals INCREASED RISK OF SYNCHRONOUS COLORECTAL LESIONS IN PATIENTS REFERRED FOR ENDOSCOPIC MUCOSAL RESECTION OF LATERAL SPREADING TUMORS

2019 ◽  
Vol 56 (3) ◽  
pp. 276-279 ◽  
Author(s):  
Maria Constanza TORELLA ◽  
Belén DUARTE ◽  
Mariano VILLARROEL ◽  
Juan LASA ◽  
Ignacio ZUBIAURRE
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Bowel Preparation ◽  
Lateral Spreading ◽  
Serrated Adenoma ◽  
Index Lesion ◽  
Mucosal Resection ◽  
Increased Risk ◽  
Lateral Spreading Tumor ◽  
Serrated Adenomas ◽  
Synchronous Lesion

ABSTRACT BACKGROUND: Endoscopic mucosal resection is one of the most frequent therapeutic alternatives for large colorectal lateral spreading tumors. There are few data on the prevalence of synchronous lesions on these patients. OBJECTIVE: To describe the prevalence of synchronous colorectal lesions in patients referred for endoscopic mucosal resection of lateral spreading tumors >20 mm. METHODS: We reviewed the endoscopic database of our Department and identified adult patients who were referred for the resection of a colorectal lateral spreading tumor >20 mm and had a diagnostic colonoscopy performed up to six months before. The proportion of patients with at least one synchronous lesion was estimated. The following features were compared between patients with and without synchronous lesions: age, gender, bowel preparation quality and cecal intubation on index colonoscopy and therapeutic colonoscopy, serrated adenoma as index lesion. RESULTS: From December 2016 to November 2017, we identified 70 patients who fulfilled inclusion criteria. Median size of lesions was 25 mm (20-45). Eighty percent were located in the right colon and 35.71% were serrated adenomas. Synchronous lesion rate was 38.57%. Bowel preparation quality was similar in both groups when comparing both index and therapeutic colonoscopies. Patients with synchronous lesions had a higher proportion of serrated adenoma as index lesion than patients without synchronous lesions [51.85% vs 25.58%, OR 3.13 (1.13-8.68), P=0.03]. CONCLUSION: We found a high prevalence of synchronous lesions among patients with a large colorectal lateral spreading tumor. This risk seems to be increased if index lesions are serrated adenomas.

scholarly journals Endoscopic mucosal resection of colonic polyps: a large prospective single centre series

Gut ◽  
2011 ◽  
Vol 60 (Suppl 1) ◽  
pp. A14-A15 ◽  
Author(s):  
G. Longcroft-Wheaton ◽  
R. Mead ◽  
M. Duku ◽  
P. Bhandari
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Colonic Polyps ◽  
Single Centre ◽  
Mucosal Resection
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