Abstract
In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding. The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy. Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey. Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded. The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05). This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.
Highlights
Colonoscopic polypectomy is an effective treatment method that reduces the mortality associated with colorectal cancer,[1] which is the second highest cause of cancer-related deaths
The study was completed with 94 patients who underwent colonoscopic polypectomy
As per the advice of the physicians who prescribed the antithrombotic medications, 108 polypectomy procedures were performed on 60 patients whose medication was continued, and 59 polypectomy procedures were performed on 34 patients whose medication was discontinued
Summary
Colonoscopic polypectomy is an effective treatment method that reduces the mortality associated with colorectal cancer,[1] which is the second highest cause of cancer-related deaths. The incidence of postpolypectomy bleeding ranges from 0.3% to 3.6% per patient.[5,6] The use of antithrombotic medications is increasing worldwide, having been shown to be effective in preventing thrombosis. In conjunction with their increasing use by the general population, their use has increased among patients undergoing endoscopic procedures.[7]. CONCLUSION: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5
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