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Endoscopic submucosal dissection for early gastric cancer without interruption of warfarin and aspirin.

Tounou S, Morita Y, Hosono T, Harada H, Hayasaka K, Katsuyama Y, Suehiro S, Nagano S, Shimizu T - Endosc Int Open (2015)

Bottom Line: He had a past medical history of metallic valve replacement for mitral valve regurgitation, coronary artery disease with bare metal stent, and coronary artery bypass graft.Warfarin and low dose aspirin had been used to prevent thromboembolic events in the metallic mitral valve and coronary artery stent.We performed gastric ESD safely on continuous warfarin and low dose aspirin without any complications.

View Article: PubMed Central - PubMed

Affiliation: Teikyo University Chiba Medical Center - Gastroenterology, Ichihara, Chiba, Japan.

ABSTRACT
Many guidelines for the management of antithrombotic therapy in endoscopic procedures state that warfarin should be replaced by heparin in high risk endoscopic procedures. However, heparin bridging therapy is costly, requires a long hospital stay, and is indicated as a risk factor for bleeding after endoscopic submucosal dissection (ESD). It is not yet clear whether it is better to perform gastric ESD on continuous warfarin therapy or heparin bridging therapy. We report the case of a 65-year-old Japanese man who had been diagnosed with early gastric cancer. He had a past medical history of metallic valve replacement for mitral valve regurgitation, coronary artery disease with bare metal stent, and coronary artery bypass graft. Warfarin and low dose aspirin had been used to prevent thromboembolic events in the metallic mitral valve and coronary artery stent. We performed gastric ESD safely on continuous warfarin and low dose aspirin without any complications.

No MeSH data available.


Related in: MedlinePlus

 Final diagnosis was intramucosal gastric cancer of 4 mm in diameter, a well differentiated adenocarcinoma with no lymphovascular infiltration (H&E, × 40).
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FI157-4:  Final diagnosis was intramucosal gastric cancer of 4 mm in diameter, a well differentiated adenocarcinoma with no lymphovascular infiltration (H&E, × 40).

Mentions: The resected specimen measured 12 × 10 mm and the early gastric cancer measured 5 × 3 mm ( Fig. 3 a, b). Unfortunately, a small mucosal slit occurred in the resected specimen during its retrieval but this did not affect the pathological examination ( Fig. 3 c). Histopathology revealed a well-differentiated adenocarcinoma of 4 mm in diameter located within the mucosal layer, with no evidence of lymphovascular infiltration. The vertical and horizontal margins were free of carcinoma (Fig.  4).


Endoscopic submucosal dissection for early gastric cancer without interruption of warfarin and aspirin.

Tounou S, Morita Y, Hosono T, Harada H, Hayasaka K, Katsuyama Y, Suehiro S, Nagano S, Shimizu T - Endosc Int Open (2015)

 Final diagnosis was intramucosal gastric cancer of 4 mm in diameter, a well differentiated adenocarcinoma with no lymphovascular infiltration (H&E, × 40).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554514&req=5

FI157-4:  Final diagnosis was intramucosal gastric cancer of 4 mm in diameter, a well differentiated adenocarcinoma with no lymphovascular infiltration (H&E, × 40).
Mentions: The resected specimen measured 12 × 10 mm and the early gastric cancer measured 5 × 3 mm ( Fig. 3 a, b). Unfortunately, a small mucosal slit occurred in the resected specimen during its retrieval but this did not affect the pathological examination ( Fig. 3 c). Histopathology revealed a well-differentiated adenocarcinoma of 4 mm in diameter located within the mucosal layer, with no evidence of lymphovascular infiltration. The vertical and horizontal margins were free of carcinoma (Fig.  4).

Bottom Line: He had a past medical history of metallic valve replacement for mitral valve regurgitation, coronary artery disease with bare metal stent, and coronary artery bypass graft.Warfarin and low dose aspirin had been used to prevent thromboembolic events in the metallic mitral valve and coronary artery stent.We performed gastric ESD safely on continuous warfarin and low dose aspirin without any complications.

View Article: PubMed Central - PubMed

Affiliation: Teikyo University Chiba Medical Center - Gastroenterology, Ichihara, Chiba, Japan.

ABSTRACT
Many guidelines for the management of antithrombotic therapy in endoscopic procedures state that warfarin should be replaced by heparin in high risk endoscopic procedures. However, heparin bridging therapy is costly, requires a long hospital stay, and is indicated as a risk factor for bleeding after endoscopic submucosal dissection (ESD). It is not yet clear whether it is better to perform gastric ESD on continuous warfarin therapy or heparin bridging therapy. We report the case of a 65-year-old Japanese man who had been diagnosed with early gastric cancer. He had a past medical history of metallic valve replacement for mitral valve regurgitation, coronary artery disease with bare metal stent, and coronary artery bypass graft. Warfarin and low dose aspirin had been used to prevent thromboembolic events in the metallic mitral valve and coronary artery stent. We performed gastric ESD safely on continuous warfarin and low dose aspirin without any complications.

No MeSH data available.


Related in: MedlinePlus