Abstract
Objectives:
This study aimed to assess the correlation between platelet aggregation levels measured using aggregometry and the incidence of postprocedural bleeding after endoscopic submucosal dissection (ESD) in patients with gastric neoplasms receiving antiplatelet agents.
Methods:
Between April 2013 and March 2020, 69 patients (47 men, 22 women) underwent gastric ESD for 82 lesions while continuously receiving antiplatelet agents. Platelet aggregation levels were assessed before ESD by using an aggregometer-based grading-type score (G-type score), reflecting the status of platelet aggregation.
Results:
Patients were administered single antiplatelet agents, such as aspirin (n = 32), cilostazol (n = 14), or thienopyridine derivatives (n = 10), while other patients received multiple antiplatelet agents (n = 13). En-bloc resection was achieved in all cases, and R0 resection was accomplished in 81 lesions (98.8%). Post-ESD bleeding was observed in nine patients. When the G-type score equal to or lower than 0 was determined as an indicator of post-ESD bleeding, the sensitivity was 100% and specificity was 28%. Multivariate analysis revealed that the G-type score equal to or lower than 0 and tumor diameter ≥ 35 mm were significant risk factors for predicting bleeding following gastric ESD.
Conclusions:
The platelet aggregation test is a promising marker for predicting the bleeding risk after gastric ESD in patients receiving antiplatelet agents.