Risk of colonoscopic post-polypectomy bleeding in patients after the discontinuation of antithrombotic therapy.

BACKGROUND/AIMS: Few studies have examined the incidence of post-polypectomy bleeding (PPB) after discontinuation of antithrombotic therapies. Therefore, this study aimed to evaluate the incidence of PPB and thromboembolic events in patients whose antithrombotic agents were discontinued before colonoscopy. MATERIALS AND METHODS: We retrospectively selected all patients who underwent colon polypectomy at a community hospital. A total of 282 patients (540 polypectomies) discontinued antithrombotic agents (group 1), and 1,648 patients (2,827 polypectomies) did not take antithrombotic agents (group 2). The cessation periods before and after polypectomies were 4 and 3 days for warfarin, 5 and 3 days for anti-platelet agents, and 7 and 5 days of combination therapy, respectively. Main outcome measurements were the incidence of PPB and thromboembolic events. RESULTS: Immediate PPB rates were 3.9% (11/282) in group 1 and 4.6% (76/1648) in group 2 (adjusted odds ratio [OR], 0.85; 95% confidence interval [CI], 0.42-1.72; p=0.65). Delayed PPB rates were 1.4% (4/282) in group 1 and 1.1% (18/1648) in group 2 (adjusted OR, 1.24; 95% CI, 0.36-4.24; p=0.732). No thromboembolic events were observed in either group. CONCLUSION: Our cessation periods were appropriate, and further shortening of these periods is possible.

Endoscopic ultrasound-guided antegrade stone removal in a patient with pancreatic stones and anastomotic stricture after end-to-side pancreaticojejunostomy.

Pancreaticoenteric anastomotic stricture can occur as a late complication of pancreatic head resection and is difficult to manage. The surgically altered anatomies of patients that have undergone pancreatic head resection make it difficult to perform pancreatic duct drainage using conventional endoscopes, and it is especially difficult to endoscopically identify stenotic pancreaticojejunal anastomoses. A 40-year-old woman was referred to our department for the treatment of symptomatic multiple pancreatic stones and anastomotic stricture after end-to-side pancreaticojejunostomy. Endoscopic ultrasound-guided pancreaticogastrostomy was performed in an attempt to avoid re-surgery. At 18 days after the initial procedure, a guidewire was successfully placed in the jejunum through the anastomotic stricture. The anastomotic stricture was dilated using a dilation balloon, and all of the stones were pushed into the jejunum using a retrieval balloon. No complications were experienced during the procedure. At 22 months after the stone removal, the main pancreatic duct displayed a decreased diameter, and no stone recurrence was detected.