Is the Reinitiation of Antiplatelet Agents Safe at 1 Week after Gastric Endoscopic Submucosal Dissection? Assessment of Bleeding Risk Using the Forrest Classification.
- Author:
Jong Yeul LEE
1
;
Chan Gyoo KIM
;
Soo Jeong CHO
;
Young Il KIM
;
Il Ju CHOI
Author Information
- Publication Type:Original Article
- Keywords: Hemorrhage; Forrest classification; Stomach neoplasms; Endoscopic mucosal resection
- MeSH: Classification*; Hemorrhage*; Logistic Models; Multivariate Analysis; Odds Ratio; Platelet Aggregation Inhibitors*; Retrospective Studies; Stomach Neoplasms; Ulcer
- From:Gut and Liver 2017;11(4):489-496
- CountryRepublic of Korea
- Language:English
- 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.
