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Gastroenterology Research and Practice
Volume 2013, Article ID 365830, 7 pages
Clinical Study

Gastric ESD under Heparin Replacement at High-Risk Patients of Thromboembolism Is Technically Feasible but Has a High Risk of Delayed Bleeding: Osaka University ESD Study Group

1Department of Gastroenterology, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan
2Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Clinical Research Building (K1), 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
3Department of Gastroenterology, Osaka Police Hospital, Kitayama-cho, Tennoji-ku, Osaka 543-0035, Japan
4Department of Gastroenterology, Sakai City Hospital, 1-1-1 Minamiyasui-cho, Sakai-ku, Sakai 590-0064, Japan
5Department of Gastroenterology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai 591-8025, Japan
6Department of Gastroenterology, Itami City Hospital, 1-100 Koyaike, Itami-shi, Hyougo 664-8540, Japan
7Department of Gastroenterology, Osaka Kousei-Nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan

Received 25 March 2013; Accepted 27 May 2013

Academic Editor: Massimo Raimondo

Copyright © 2013 Toshiyuki Yoshio et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objectives. Heparin replacement (HR) is often performed in patients with a high risk of thrombosis undergoing endoscopic procedures. However, information about the influence of HR is scarce. The aim of this study is to assess the clinical impact of HR for gastric endoscopic submucosal dissection (ESD). Methods. This is a retrospective study comprising approximately 1310 consecutive gastric neoplasms in 1250 patients, who underwent ESD in 5 institutes. We assessed the clinical findings and outcomes of ESD under HR, compared to ESD without HR as control. Results. A total of 24 EGC lesions in 24 patients were treated by ESD under HR. In the HR group, the complete en-bloc resection rate was 100%. The delayed bleeding rate was, however, higher in the HR group than in the controls (38% versus 4.6%). The timing of bleeding in the HR group was significantly later than in controls. In the control group, 209 patients discontinued antithrombotic therapy during perioperative period, and their delayed bleeding rate was not different from those without antithrombotic therapy (5.7% versus. 4.4%). A thromboembolic event was encountered in 1 patient under HR after delayed bleeding. Conclusion. ESD under HR is technically feasible but has a high risk of delayed bleeding.