1Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
2Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
Copyright © 2021 Korean Society of Gastrointestinal Endoscopy
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ATA group (n=18) | Non-ATA group (n=202) | p-value | |
---|---|---|---|
Age, median (range) | 73.5 (56–88) | 68 (37–94) | 0.40 |
Sex, male/female | 12/6 | 119/83 | 0.52 |
Disease | 0.79 | ||
Malignant biliary obstruction | 16 | 189 | |
Benign biliary stricture | 2 | 13 | |
Number of comorbidities (n) | <0.001 | ||
>3 | 0 | 1 | |
3 | 4 | 6 | |
2 | 7 | 22 | |
1 | 7 | 57 | |
0 | 0 | 116 | |
Comorbidities (n)a) | |||
Hypertension | 9 | 48 | |
Diabetes mellitus | 3 | 33 | |
Hyperlipidemia | 4 | 19 | |
Coronary artery disease | 1 | 0 | |
Cerebral infraction | 8 | 0 | |
Atrial fibrillation | 4 | 0 | |
Deep vein thrombosis | 2 | 1 | |
Valvular heart disease | 0 | 1 | |
Liver cirrhosis | 0 | 2 | |
Congestive heart failure | 0 | 1 | |
Others | 3 | 9 | |
Hemoglobin (g/dL, mean±SD) | 11.1±2.13 | 10.8±1.92 | 0.32 |
Platelet (×104/μL, mean±SD) | 24.6±7.84 | 25.1±12.45 | 0.40 |
PT-INR (mean±SD) | 1.45±0.85 | 1.15±0.33 | 0.02b) |
n=18 | |
---|---|
Antiplatelet agents | |
Aspirin | 5 |
Thienopyridine | 3 |
Antiplatelet agent other than thienopyridine | 4 |
Aspirin + thienopyridine | 1 |
Anticoagulant agents | |
Warfarin | 0 |
Direct oral anticoagulant | 5 |
Factors | Bleeding group (n=3) | Non-bleeding group (n=217) |
Univariate |
|
---|---|---|---|---|
OR | p-value | |||
Antithrombotic therapy | 33.3% (1/3) | 78.3% (17/217) | 5.88 | 0.10 |
Age (≥80 yr) | 0% (0/3) | 10.5% (23/217) | 0 | 0.55 |
Platelet (<10×104/μL) | 0% (0/3) | 5.9% (13/217) | 0 | 0.66 |
PT-INR (≥1.5) | 0% (0/3) | 2.7% (6/217) | 0 | 0.77 |
Primary disease (malignancy) | 66.6% (2/3) | 93.5% (203/217) | 0.13 | 0.06 |
Approach route (transhepatic) | 33.3% (1/3) | 54.3% (118/217) | 0.41 | 0.46 |
Ascites (present) | 33.3% (1/3) | 46.5% (101/217) | 0.57 | 0.64 |
Stent (FCSEMS) | 100.0% (3/3) | 79.7% (173/217) | - | 0.38 |
Procedure time (>25 min) | 33.3% (1/3) | 42.8% (93/217) | 0.66 | 0.74 |
Dilation device (electrical) | 100.0% (3/3) | 37.3% (81/217) | - | 0.02a) |
Aspirin | Continuation |
---|---|
Thienopyridine derivatives | Withdraw for 5 days and replaced with aspirin |
Antiplatelet agents other than thienopyridine | Withdraw for 1 day |
Warfarin | PT-INR greater than the therapeutic range |
Withdraw for 3 days with replacement by intravenous heparin (10,000–20,000 units/day) | |
Stop intravenous heparin 4–6 hr before EUS-BD | |
DOACs | Withdraw from 24 hr before EUS-BD |
ATA group (n=18) | Non-ATA group (n=202) | p-value | |
---|---|---|---|
Age, median (range) | 73.5 (56–88) | 68 (37–94) | 0.40 |
Sex, male/female | 12/6 | 119/83 | 0.52 |
Disease | 0.79 | ||
Malignant biliary obstruction | 16 | 189 | |
Benign biliary stricture | 2 | 13 | |
Number of comorbidities (n) | <0.001 | ||
>3 | 0 | 1 | |
3 | 4 | 6 | |
2 | 7 | 22 | |
1 | 7 | 57 | |
0 | 0 | 116 | |
Comorbidities (n) |
|||
Hypertension | 9 | 48 | |
Diabetes mellitus | 3 | 33 | |
Hyperlipidemia | 4 | 19 | |
Coronary artery disease | 1 | 0 | |
Cerebral infraction | 8 | 0 | |
Atrial fibrillation | 4 | 0 | |
Deep vein thrombosis | 2 | 1 | |
Valvular heart disease | 0 | 1 | |
Liver cirrhosis | 0 | 2 | |
Congestive heart failure | 0 | 1 | |
Others | 3 | 9 | |
Hemoglobin (g/dL, mean±SD) | 11.1±2.13 | 10.8±1.92 | 0.32 |
Platelet (×104/μL, mean±SD) | 24.6±7.84 | 25.1±12.45 | 0.40 |
PT-INR (mean±SD) | 1.45±0.85 | 1.15±0.33 | 0.02 |
n=18 | |
---|---|
Antiplatelet agents | |
Aspirin | 5 |
Thienopyridine | 3 |
Antiplatelet agent other than thienopyridine | 4 |
Aspirin + thienopyridine | 1 |
Anticoagulant agents | |
Warfarin | 0 |
Direct oral anticoagulant | 5 |
ATA group (n=18) | Non ATA group (n=202) | p-value | |
---|---|---|---|
Overall | 2 | 34 | 0.76 |
Bleeding | 1 | 2 | 0.10 |
Peritonitis | 0 | 10 | |
Fever | 0 | 7 | |
Cholangitis | 0 | 6 | |
Cholecystitis | 1 | 3 | |
Biloma | 0 | 1 | |
Pneumonia | 0 | 1 | |
Others | 0 | 4 | |
Hemoglobin decrease (g/dL, mean±SD) | 0.77±0.48 | 0.75±0.57 | 0.43 |
Blood transfusion | 1 | 2 | 0.21 |
Thromboembolic events | 0 | 1 | 0.76 |
Cerebral infraction | 0 | 1 | |
Deep vein thrombosis | 0 | 0 |
Case | Age/sex | Primary disease | EUS-BD | Dilation device | Stent | ATD | Management of ATD | Timing | Symptom | Grading | Type of bleeding | Hemostasis treatment | Transfusion |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 64/M | Pancreatic cancer | CDS | Electrical | Metal | Clopidogrel | Continuation of aspirin | Post | Melena | Moderate | Endoscopic examination with no evidence of active bleeding | Conservative treatment | + |
2 | 57/F | Lung cancer | CDS | Electrical | Metal | - | - | Intra | Hemobilia | Moderate | Hemobilia | Interventional radiology | + |
3 | 64/F | Anastomosis stricture | HES | Electrical | Metal | - | - | Post | Melena | Moderate | Aneurysm | Interventional radiology | + |
Factors | Bleeding group (n=3) | Non-bleeding group (n=217) | Univariate |
|
---|---|---|---|---|
OR | p-value | |||
Antithrombotic therapy | 33.3% (1/3) | 78.3% (17/217) | 5.88 | 0.10 |
Age (≥80 yr) | 0% (0/3) | 10.5% (23/217) | 0 | 0.55 |
Platelet (<10×104/μL) | 0% (0/3) | 5.9% (13/217) | 0 | 0.66 |
PT-INR (≥1.5) | 0% (0/3) | 2.7% (6/217) | 0 | 0.77 |
Primary disease (malignancy) | 66.6% (2/3) | 93.5% (203/217) | 0.13 | 0.06 |
Approach route (transhepatic) | 33.3% (1/3) | 54.3% (118/217) | 0.41 | 0.46 |
Ascites (present) | 33.3% (1/3) | 46.5% (101/217) | 0.57 | 0.64 |
Stent (FCSEMS) | 100.0% (3/3) | 79.7% (173/217) | - | 0.38 |
Procedure time (>25 min) | 33.3% (1/3) | 42.8% (93/217) | 0.66 | 0.74 |
Dilation device (electrical) | 100.0% (3/3) | 37.3% (81/217) | - | 0.02 |
DOACs, direct oral anticoagulants; EUS-BD, endoscopic ultrasound-guided biliary drainage; PT-INR, prothrombin time-international normalized ratio.
ATA, antithrombotic agent; PT-INR, prothrombin time-international normalized ratio; SD, standard deviation. Some overlap was noted. Statistically significant (
ATA, antithrombotic agent; SD, standard deviation.
ATD, antithrombotic drug; CDS, choledocoduodenostomy; EUS-BD, endoscopic ultrasound-guided biliary drainage; HES, hepaticoenterostomy.
FCSEMS, fully covered self-expandable metal stent; OR, odds ratio; PT-INR, prothrombin time-international normalized ratio. Statistically significant (