Response

Abstract

My colleagues and I thank Professor Chiang1Chiang H.-C. The risk of using antiplatelet and/or anticoagulant treatment for hemorrhagic adverse events during EUS-guided biliary drainage.Gastrointest Endosc. 2023; 97: 1170Abstract Full Text Full Text PDF Google Scholar for his constructive comments regarding our article “Antiplatelet and/or anticoagulant treatment dose not increase hemorrhagic adverse events during EUS-guided biliary drainage,”2Ogura T. Nishioka N. Ueno S. et al.Antiplatelet and/or anticoagulant treatment does not increase hemorrhagic adverse events during EUS-guided biliary drainage.Gastrointest Endosc. 2020; 92: 659-666Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar and we welcome the opportunity to respond. As Professor Chiang mentioned, the sample size was small because bleeding itself was not frequently observed; however, the number of patients who underwent EUS-BD was relatively large. This fact may reflect that bleeding events themselves may be rare. We mentioned this limitation in the text, and we also stated that our results should be evaluated in a large patient cohort. According to Chiang’s analysis, resuming anticoagulant/antiplatelet (AC/AP) may be a risk factor for bleeding.1Chiang H.-C. The risk of using antiplatelet and/or anticoagulant treatment for hemorrhagic adverse events during EUS-guided biliary drainage.Gastrointest Endosc. 2023; 97: 1170Abstract Full Text Full Text PDF Google Scholar However, as we mentioned in the text, the patients’ backgrounds were various; also, other data associated with bleeding were not presented because of the retrospective nature of the study. However, in our study, visible bleeding was observed in only 1 patient who did not receive AC/AP treatment. In clinical practice, a fall in hemoglobin does not matter so much. In addition, a covered self-expandable metal stent was deployed during EUS-BD; therefore, a compression effect was obtained if bleeding occurred as an adverse event. Moreover, according to another recent study,3Okuno N. Hara K. Mizuno N. et al.Outcomes of endoscopic ultrasound-guided biliary drainage in patients undergoing antithrombotic therapy.Clin Endosc. 2021; 54: 596-602Crossref PubMed Scopus (4) Google Scholar EUS-BD can be performed in patients who have undergone AC/AP treatment. Although further study is needed, as Chiang1Chiang H.-C. The risk of using antiplatelet and/or anticoagulant treatment for hemorrhagic adverse events during EUS-guided biliary drainage.Gastrointest Endosc. 2023; 97: 1170Abstract Full Text Full Text PDF Google Scholar points out, we think that EUS-BD can be performed safely. Once again, we would like to thank Professor Chiang for these valuable comments. The author disclosed no financial relationships.