Gut Liver.  2017 Jul;11(4):489-496. 10.5009/gnl16232.

Is the Reinitiation of Antiplatelet Agents Safe at 1 Week after Gastric Endoscopic Submucosal Dissection? Assessment of Bleeding Risk Using the Forrest Classification

• Lee JY
• Kim CG
• Cho SJ
• Kim YI
• Choi IJ

• KMID: 2412228
• DOI: http://doi.org/10.5009/gnl16232

Abstract

BACKGROUND/AIMS
Delayed bleeding after gastric endoscopic submucosal dissection (ESD) commonly occurs within 3 days, but it may also occur after 1 week following ESD, especially in antiplatelet agent users. We evaluated the risk of delayed bleeding in post-ESD ulcers using the Forrest classification.
METHODS
Registry data on the Forrest classification of post-ESD ulcers (n=371) at 1 week or 2 weeks after ESD were retrospectively evaluated. The Forrest classification was categorized into two groups: increased risk (Forrest Ia to IIc) or low risk (Forrest III). The odds ratios (ORs) were calculated using logistic regression analysis.
RESULTS
Among 371 post-ESD ulcers, one ulcer (0.3%) was classified as Forrest Ib, two (0.5%) as Forrest IIa, 17 (4.6%) as Forrest IIb, 172 (46.4%) as Forrest IIc, and 179 (48.2%) as Forrest III. The proportion of increased-risk ulcers was 72.2% (140/194) at 1 week after ESD, which decreased to 29.4% (52/177) at 2 weeks after ESD (p<0.001). In the multivariate analysis, a post-ESD ulcer at 1 week after ESD (OR, 7.54), younger age (OR, 2.17), and upper/middle ulcer location (OR, 2.05) were associated with increased-risk ulcers.
CONCLUSIONS
One week after ESD, ulcers still have an increased risk of bleeding when assessed using the Forrest classification. This risk should be considered when resuming antiplatelet therapy.

Keyword

Hemorrhage; Forrest classification; Stomach neoplasms; Endoscopic mucosal resection

MeSH Terms

Adult
Aged
Aged, 80 and over
Endoscopic Mucosal Resection/adverse effects
Female
Gastroscopy/adverse effects/methods
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Peptic Ulcer Hemorrhage/drug therapy/*etiology/surgery
Platelet Aggregation Inhibitors/*administration & dosage
Postoperative Hemorrhage/*etiology
Postoperative Period
Registries
Retrospective Studies
Risk Assessment/*methods
Risk Factors
Stomach Ulcer/*complications/drug therapy/surgery
Time Factors
Platelet Aggregation Inhibitors