| Theme | Towards Standardization of ESD Procedures | |
|---|---|---|
| Title | Management of Antithrombotic Agents during Perioperative Period Case ESD | |
| Publish Date | 2017/04 | |
| Author | Katsuhiro Mabe | Department of Gastroenterology, Naitonal Hakodate Hospital |
| Author | Akihisa Nakamura | Department of Gastroenterology, Naitonal Hakodate Hospital |
| Author | Kimitoshi Kubo | Department of Gastroenterology, Naitonal Hakodate Hospital |
| Author | Mototsugu Kato | Department of Gastroenterology, Naitonal Hakodate Hospital |
| [ Summary ] | The new edition of the guideline for managing antithrombotic agents during periendoscopic period had been produced by the Japan Gastroenterological Endoscopy Society in 2012. The cessation period of the antithrombotic agents was decided by the risk conditions of thromboembolism associated with withdrawal of those agents. One of the techniques that are categorized as high bleeding is the endoscopic submucosal dissection (ESD). For high thrombotic risk patients, it is recommended that aspirin and thienopyridine should be maintained and then replaced with cilostazol or aspirin as a bridging therapy in case of ESD. This also pertains to an anticoagulant that should be replaced with heparin as a bridging therapy. If possible, ESD should be postponed until anti-thrombotic agents can be withdrawn. According to the need, ESD should be carried out under special caution for bleeding and thromboembolism with informed consent for patient and family before the procedure. |
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