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• W2977975248 abstract "Introduction: Raised lesions of dysplastic Barrett's Esophagus (BE) are treated with endoscopic mucosal resection (EMR) prior to ablative therapy. It has been reported that the most common complication of EMR is bleeding with estimates approaching 10%. We seek to establish our EMR bleeding event rate and determine whether antiplatelet and anticoagulation use is associated with post EMR bleeding. Methods: We retrospectively reviewed a prospectively maintained database from our specialized Barrett's Esophagus Unit of individuals from 1995-2015 who underwent EMR for dysplastic BE. Corresponding electronic medical records were reviewed to establish if patients had been taking aspirin, clopidogrel, or warfarin peri-procedurally and determined whether post EMR bleeding occurred. It is our practice to hold antiplatelet medications 5-days prior to procedure if tolerated, and those maintain an INR < 1.5 for those on warfarin. High risk individuals on warfarin are bridged with low molecular weight heparin. Results: We reviewed 3,114 EMR sessions which were associated with 1,312 unique patients and found 41 (1.3%) total episodes of bleeding. Aspirin or clopidogrel use was not significantly associated with bleeding (OR 0.5, 95% CI 0.23-1.19, p = 0.11), nor was warfarin use alone associated with bleeding (OR 0.42, 95% 0.06-3.12, p = 0.33). Though the absolute risk was low, combination blood thinner therapy was associated with the highest risk of bleeding. Aspirin and clopidogrel use (OR 4.30, 95% CI 1.44-12.84, p = 0.03), and bridging therapy using low molecular weight heparin (OR: 41.6, 95% CI 3.51-493.17, p = 0.03) were significantly associated with bleeding. Summary of bleeding rates and bleeding risk is shown in Table 1. Conclusion: Esophageal EMR for the treatment of dysplastic BE is a safe procedure with a low risk of bleeding. Our overall bleeding rate was 1.3%, which is much less than other prior estimates. This may be due to our practice of with-holding antiplatelet agents for five days prior to EMR and maintaining INR < 1.5. Aspirin or clopidogrel use alone is not significantly associated with bleeding, however dual antiplatelet therapy carries the highest risk of bleeding.Figure 1" @default.
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• W2977975248 date "2015-10-01" @default.
• W2977975248 modified "2023-09-27" @default.
• W2977975248 title "Low Bleeding Rates Associated With Esophageal Endoscopic Mucosal Resection for the Treatment of Dysplastic Barrettʼs Esophagus: ACG Governors Award for Excellence in Clinical Research" @default.
• W2977975248 doi "https://doi.org/10.14309/00000434-201510001-01512" @default.
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