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Oral anticoagulants but not antiplatelet agents increase the risk of delayed bleeding after endoscopic papillectomy: a large study in a tertiary referral center.
Meunier, Camille; Lisotti, Andrea; Gupta, Vikas; Lemaistre, Anne-Isabelle; Fumex, Fabien; Gincul, Rodica; Lefort, Christine; Lepillez, Vincent; Bourdariat, Raphael; Napoléon, Bertrand.
Afiliação
  • Meunier C; Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.
  • Lisotti A; Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.
  • Gupta V; Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy.
  • Lemaistre AI; Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.
  • Fumex F; Gastroenterology Unit, Sunshine Coast University Hospital, Queensland, Australia.
  • Gincul R; Pathology Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.
  • Lefort C; Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.
  • Lepillez V; Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.
  • Bourdariat R; Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.
  • Napoléon B; Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, 55 avenue Jean Mermoz, 69008, Lyon, France.
Surg Endosc ; 36(10): 7376-7384, 2022 Oct.
Article em En | MEDLINE | ID: mdl-35233659
BACKGROUND: Endoscopic papillectomy (EP) is an effective curative treatment in patients with ampullary adenomas. However, EP is burdened by a not-negligible risk of bleeding. The aim of this study was to determine risk factors for delayed bleeding after EP. METHODS: A retrospective analysis of a prospectively-collected database was performed, retrieving all EP performed over a 20-year period. Anti-thrombotic treatments were managed according to guidelines. Delayed bleeding was defined as overt gastrointestinal bleeding or drop in haemoglobin level. Multivariate logistic regression was used to identify variables related to delayed bleeding. RESULTS: Three-hundred-seven patients (48.5% male, median age 68-year-old) entered the study; of them, 51 (16.6%) received anti-thrombotic treatments. Delayed bleeding occurred in 44 (14.3%) patients. No difference was observed in patients receiving antiplatelet agents. Multivariate analysis identified oral anticoagulant agents (odd Ratio 4.37 [2.86-5.95]) and procedural bleeding (OR 2.22 [1.10-4.40]) as independently related to delayed bleeding; in patients with no procedural bleeding, oral anticoagulant agents (OR 5.63 [2.25-9.83]) and ampullary tumor size (OR 1.07 [1.01-1.13]) were independently related to delayed bleeding. Patients on anticoagulant agents presented significantly higher need for blood transfusion (16.7 vs. 1.5%); no difference in intensive care unit admission, surgery or mortality was observed. CONCLUSIONS: This study demonstrates that patients on oral antiplatelet agents do not present increased risk for post-EP delayed bleeding. EP represents a valid alternative to surgery even in patients on anticoagulant agents, despite significantly increased risk of delayed bleeding. A tailored approach to those cases should be planned.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Neoplasias do Ducto Colédoco / Neoplasias Duodenais Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Neoplasias do Ducto Colédoco / Neoplasias Duodenais Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male Idioma: En Ano de publicação: 2022 Tipo de documento: Article