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Original Article
Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy
Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Akira Miyano, Daiki Fumihara, Moaz Elshair
Clin Endosc 2021;54(4):596-602.   Published online February 17, 2021
DOI: https://doi.org/10.5946/ce.2020.194
AbstractAbstract PDFPubReaderePub
Background
/Aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy.
Methods
This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013 and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. We compared the bleeding event rates among patients who received and those who did not receive antithrombotic agents.
Results
A total of 18 patients (8.1%) received antithrombotic agents and 202 patients (91.8%) did not. Three patients experienced bleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and two patients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) was a cerebral infarction in a patient in the non-antithrombotic group.
Conclusions
The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleeding event rates were not significantly different from those in patients not receiving antithrombotic therapy.

Citations

Citations to this article as recorded by  
  • The New Potential for Using Franseen Needles in Interventional EUS
    Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Yoshitaro Yamamoto, Takashi Kondo
    Internal Medicine.2024; 63(20): 2723.     CrossRef
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    The Korean Journal of Gastroenterology.2024; 83(6): 217.     CrossRef
  • International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Gut and Liver.2024; 18(5): 764.     CrossRef
  • Novel drill dilator facilitates endoscopic ultrasound‐guided hepaticogastrostomy
    Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Masanori Yamada, Toshitaka Fukui
    Digestive Endoscopy.2023; 35(3): 389.     CrossRef
  • Response
    Takeshi Ogura
    Gastrointestinal Endoscopy.2023; 97(6): 1171.     CrossRef
  • Rescue technique for bleeding after placement of plastic stent in EUS–guided hepaticogastrostomy (with videos)
    Akihisa Ohno, Nao Fujimori, Noboru Harada
    Endoscopic Ultrasound.2023; 12(3): 347.     CrossRef
  • Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis
    Suprabhat Giri, Babu P. Mohan, Vaneet Jearth, Aditya Kale, Sumaswi Angadi, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram
    Gastrointestinal Endoscopy.2023; 98(4): 515.     CrossRef
  • Endoscopic Ultrasound-Guided Biliary Interventions in Liver Disease
    Shyam Vedantam, Sunil Amin
    Clinics in Liver Disease.2022; 26(1): 101.     CrossRef
  • B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video)
    Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Daiki Fumihara, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Tsukasa Yasuda, Moaz Elshair
    Endoscopic Ultrasound.2022; 11(4): 319.     CrossRef
  • The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome
    Zhengwang Liu, Xiaotang Qiu, Hua Yang, Xiaocui Wu, Wenjing Ye, Xinbing Zheng, Li Yuan
    Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1.     CrossRef
  • Clopidogrel

    Reactions Weekly.2022; 1936(1): 165.     CrossRef
  • 6,648 View
  • 135 Download
  • 11 Web of Science
  • 12 Crossref
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Review
Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Hyun Lim, Eun Jeong Gong, Byung-Hoon Min, Seung Joo Kang, Cheol Min Shin, Jeong-Sik Byeon, Miyoung Choi, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun
Clin Endosc 2020;53(6):663-677.   Published online November 26, 2020
DOI: https://doi.org/10.5946/ce.2020.192
AbstractAbstract PDFPubReaderePub
Antithrombotic agents, including antiplatelet agents and anticoagulants, are increasingly used in South Korea. The management of patients using antithrombotic agents and requiring gastrointestinal endoscopy is an important clinical challenge. Although clinical practice guidelines (CPGs) for the management of patients receiving antithrombotic agents and undergoing gastrointestinal endoscopy have been developed in the Unites States, Europe, and Asia Pacific region, it is uncertain whether these guidelines can be adopted in South Korea. After reviewing current CPGs, we identified unmet needs and recognized significant discrepancies in the clinical practice among regions. This is the first CPG in Korea providing information that may assist endoscopists in the management of patients on antithrombotic agents who require diagnostic or elective therapeutic endoscopy. This guideline was developed through the adaptation process as an evidence-based method, with four guidelines retrieved by systematic review. Eligible guidelines were evaluated according to the Appraisal of Guidelines for Research and Evaluation II process, and 13 statements were established using a grading system. This guideline was reviewed by external experts before an official. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

Citations

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    Denisse Camille Dayto, Wojciech Blonski, Tea Reljic, Farina Klocksieben, Jeffrey Gill, Rene D. Gomez-Esquivel, Brijesh Patel, Pushpak Taunk, Andrew Sephien, Camille Thelin, Ambuj Kumar
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  • Chronic Kidney Disease Increases Risk of Delayed Post‐Polypectomy Bleeding: A Large‐Scale Propensity Score‐Matched Analysis
    Hye Kyung Hyun, Nak‐Hoon Son, So Hyeon Gwon, Hyun Chul Lim, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim, Tae‐Hyun Yoo, Shin‐Wook Kang, Hae‐Ryong Yun, Cheal Wung Huh
    United European Gastroenterology Journal.2025; 13(5): 759.     CrossRef
  • Clinical Advances in Percutaneous Endoscopic Gastrostomy: A 2023 Clinical Practice Guideline-Based Review
    Ji Yong Ahn
    The Korean Journal of Medicine.2025; 100(2): 54.     CrossRef
  • Minimum Platelet Count Threshold for Safe Colonoscopic Polypectomy: A Large-Scale Propensity Scored-Matched Analysis
    Hye Kyung Hyun, Nak-Hoon Son, Cheal Wung Huh, Hyun Chul Lim, So Hyeon Gwon, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim
    American Journal of Gastroenterology.2025; 120(12): 2918.     CrossRef
  • Management for endoscopic procedures in patients taking antithrombotic agents
    Chung Hyun Tae, Ki-Nam Shim
    Journal of the Korean Medical Association.2025; 68(8): 536.     CrossRef
  • Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
    Gut and Liver.2024; 18(1): 10.     CrossRef
  • A systematic critical appraisal of clinical practice guidelines of antithrombotic agents in gastrointestinal endoscopy using the AGREE II tool
    Denisse Camille Dayto, Wojciech Blonski, Tea Reljic, Farina Klocksieben, Jeffrey Gill, Rene D. Gomez‐Esquivel, Brijesh Patel, Pushpak Taunk, Andrew Sephien, Camille Thelin, Ambuj Kumar
    Journal of Gastroenterology and Hepatology.2024; 39(5): 818.     CrossRef
  • The Impact of Sedation on Cardio-Cerebrovascular Adverse Events after Surveillance Esophagogastroduodenoscopy in Patients with Gastric Cancer: A Nationwide Population-Based Cohort Study
    Sang Yoon Kim, Jun Kyu Lee, Kwang Hyuck Lee, Jae-Young Jang, Byung-Wook Kim
    Gut and Liver.2024; 18(2): 245.     CrossRef
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
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  • Anticoagulants Are a Risk Factor for Delayed Bleeding after Colorectal Endoscopic Submucosal Dissection: A HASID Multicenter Study
    Seong-Jung Kim, Jun Lee, Hyo-Yeop Song, Geom Seog Seo, Byung Chul Jin, Sang-Wook Kim, Dong Hyun Kim, Hyun-Soo Kim, Hyung-Hoon Oh, Dae-Seong Myung, Young-Eun Joo
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    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
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  • Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants
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  • Clinical practice guidelines for percutaneous endoscopic gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
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  • Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
    Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
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  • Predicting the Bleeding Risk for Patients on Anticoagulant Therapy Prior to Gastric Endoscopic Submucosal Dissection
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  • Utility of a deep learning model and a clinical model for predicting bleeding after endoscopic submucosal dissection in patients with early gastric cancer
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  • 1,078 Download
  • 22 Web of Science
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Original Article
Risk Factors for Dieulafoy Lesions in the Upper Gastrointestinal Tract
Hae Jin Shin, Jong Seok Ju, Ki Dae Kim, Seok Won Kim, Sung Hoon Kang, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong
Clin Endosc 2015;48(3):228-233.   Published online May 29, 2015
DOI: https://doi.org/10.5946/ce.2015.48.3.228
AbstractAbstract PDFPubReaderePub
Background/Aims

The purpose of this study is to verify the risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.

Methods

A case-control study was performed by reviewing the electronic medical records of 42 patients who were admitted to a tertiary medical center in the Daejeon region for Dieulafoy lesions from September 2008 to October 2013, and the records of 132 patients who were admitted during the same period and who underwent endoscopic examination for reasons other than bleeding. We analyzed clinical and endoscopic findings retrospectively, and searched for risk factors associated with Dieulafoy lesion formation.

Results

All 42 patients diagnosed with Dieulafoy lesion had accompanying bleeding, and the location of the bleeding was proximal in 25 patients (59.5%), the middle portion in seven patients (16.7%), and distal in 10 patients (23.8%). Antiplatelet agents (p=0.022) and alcohol (p=0.001) use showed statistically significant differences between the two groups. The odds ratios (95% confidence intervals) of the two factors were 2.802 (1.263 to 6.217) and 3.938 (1.629 to 9.521), respectively.

Conclusions

This study showed that antiplatelet agents and alcohol consumption were risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.

Citations

Citations to this article as recorded by  
  • Can Segmental Branch Embolization of the Left Gastric Artery Be an Alternative in the Treatment of Recurrent Dieulafoy Lesion Bleeding? A Case report
    Gamze Sönmez, Serez İleri, Ferdi Çay, Bora Peynircioğlu, Onur Keskin
    Akademik Gastroenteroloji Dergisi.2024; 23(2): 67.     CrossRef
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    John Joyce, Vishnu Kumar, Dayana Nasr, Ganesh Aswath, Hafiz M. Khan, Savio John
    Journal of Investigative Medicine High Impact Case Reports.2024;[Epub]     CrossRef
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  • SEVERE GASTROINTESTINAL BLEEDING IN A PATIENT WITH DIEULAFOY'S LESION: A CASE REPORT STUDY
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    Jonathan J Cho, Chelsea M Forbes, Benjamin D Fiore, Joshua D McCarron, Leybelis Padilla
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    Vikas Pemmada, Ganesh Bhat, Athish Shetty, Bharath Kumar Bhat, Megha Murali, Geetha Vasudevan
    ACG Case Reports Journal.2023; 10(6): e01053.     CrossRef
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    Bünyamin SARITAŞ, Şehmus ÖLMEZ, Adnan TAŞ, Nevin AKÇAER ÖZTÜRK, Banu KARA
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    Daniel Felipe Barrantes Murillo, Michael Tillson, Jennifer W. Koehler, Maninder Sandey
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    Amanda R Levy, Sierra Broad, James R Loomis III, Julie A Thomas
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    Adnan Malik, Faisal Inayat, Muhammad Hassan Naeem Goraya, Talal Almas, Rizwan Ishtiaq, Sohira Malik, Zahid Ijaz Tarar
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    Jairo Alonso Sierra-Avendaño, Fabián Andrés Mejía-Casadiegos, María Paula Pérez-Barón, Gabriel Eduardo Pérez-García
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  • Massive Gastrointestinal Bleeding from a Jejunal Dieulafoy Lesion: An Extraordinary Presentation
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  • Postural Syncope and Constipation: An Unusual Presentation of a Duodenal Dieulafoy’s Lesion
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  • 11,472 View
  • 102 Download
  • 25 Web of Science
  • 24 Crossref
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