Su1736 The Effect of Discontinuation of Antiplatelet Agents on Colonoscopic Postpolypectomy Bleeding

Abstracts

number of cases with partial polyp borders demarcation increased to 8% respectively 25% but it was still absent in 92% respectively 74% of the cases. After AA polyp borders demarcation was complete in 81% (69/85) with WL, 96% (82/85) with NBI and 98% (83/85) with NBI+NF. The pit pattern visualization, under WL before AA was non present in 100% (85/85) of cases with a marginal rise under NBI and NBI+NF. After AA, the pit pattern visualization was considerable increased in all groups reaching its maximum under NBI+NF where it was either complete or present in most of the surface in 98% (83/85) of cases. Conclusion: Diluted AA seems to be a valuable tool for delineation as for characterization of the pit pattern of serrated polyps. Table 1

N[85 WL NBI Near-F WL+AA NBI+AA Near-F+AA NZ85

WL NBI Near-F WL+AA NBI+AA Near-F+AA

Distinctive Border non present N(%)

Distinctive Border partial (%)

Distinctive Border Complete (%)

83(98) 78(92) 63(74) 0(0) 0(0) 0(0) Pit Pattern non present N(%) 85(100) 81(95) 62(73) 4(5) 0(0) 0(0)

2(2) 7(8) 21(25) 16(19) 3(4) 2(2) Pit Pattern minimal present N(%) 0(0) 4(5) 21(25) 22(26) 6(7) 2(2)

0(0) 0(0) 1(1) 69(81) 82(96) 83(98) Pit Pattern Pit Pattern present in most complete N(%) N(%) 0(0) 0(0) 0(0) 0(0) 2(2) 0(0) 59(69) 0(0) 79(93) 0(0) 28(33) 55(65)

Max polyp size  1.2cm No. of polyps removed/patient; mean  SD Histology (%) Neoplastic Non-neoplastic Total no. of polyps removed Location of polyps Left Right Gross morphology Sessile(Is) Subpedunculated(Isp) Pedunculated(Ip) Bowel preparation Excellent or good Adequate or poor Submucosal injection Endo-loop use Endoscopist experience Staff ( 2 years) Fellow(<2 years)

Patients with postpolypectomy bleeding (N[38)

Patients without postpolypectomy bleeding (N[458)

P value

28(73.7%)

159(34.7%)

<0.001*

2.00  1.09

1.68  1.04

0.069

6(15.8%) 32(84.2%) 76

26(5.7%) 432(94.3%) 769

38(50%) 38(50%)

468(60.9%) 301(39.1%)

25(32.9%) 31(40.8%) 20(26.3%)

266 (34.6%) 360 (46.8%) 143 (18.6%)

23(60.5%) 15 (39.5%) 14(36.8%) 2(5.3%)

287(62.7%) 171(37.3%) 76(16.6%) 17(3.7%)

25(65.8%) 13(34.2%)

333(72.7%) 125(27.3%)

0.015*

ns 0.065

0.254

0.706

0.002* 0.634 0.360

*

means significant statistic different.

Su1736 The Effect of Discontinuation of Antiplatelet Agents on Colonoscopic Postpolypectomy Bleeding Chih-Chien Yao*, Keng-Liang Wu, Yi-Chun Chiu, Wei-Chen Tai, Chih-Ming Liang, Seng-Kee Chuah Division of Hepato-gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan, Kaohsiung, Taiwan Background and Aims: Bleeding is the most encountered complication after the procedures of colonoscopic polypectomies. Several factors associated with postpolypectomy bleeding have been discussed in the literature but whether antiplatelet agents increase the risk remains controversial. The decision and time to discontinue antiplatelet agents before polypectomy is still unclear. This study aimed to assess the effect of discontinuation of antiplatelet agents on postpolypectomy bleeding and identify the risk factors associated this adverse event. Methods: Patients who received colonoscopic polypectomy between November 2013 and September 2014 were recruited into the retrospective study. Patients’ demographics, clinical parameters, polyp characteristics, prescription of antiplatelets, and the prevalence of immediate or delay postpolypectomy bleeding were reviewed from electronic medical records. Multiple regression analysis was performed to identify independent risk factors associated with postpolypectomy bleeding. Results: This study enrolled 496 patients and a total of 845 polyps were removed. The bleeding rate was significantly higher in patients with antiplatelet therapy (14.9% versus 6.5%, pZ0.017). In multiple logistic regression analysis, antiplatelet users (hazard ratio:5.97; 95% confidence interval: 1.37-26.02, p Z 0.017) and bigger polyp removal (cut level 11.5mm, hazard ratio:1.42, 95% confidence interval: 1.19-1.71, p < 0.001) were the significant factors associated with postpolypectomy bleeding. Among the antiplatelet users, discontinuation of antiplatelet 5-7days before polypectomy was the independent protective factor of bleeding (hazard ratio: 0.12, 95% confidence interval: 0.02-0.84, pZ0.03), especially when polyp  12mm. Conclusions: This study suggested that the use of antiplatelets and bigger polyp size are associated with colonoscopic post-polypectomy bleeding. Discontinuation of antiplatelet 5-7 days before polypectomy could decrease the bleeding events especially when the size of the polyp is  12mm. Table 1. The characteristics in patients with and without post-

polypectomy bleeding Patients with postpolypectomy bleeding (N[38)

Patients without postpolypectomy bleeding (N[458)

P value

2-25

3-30

ns

13.13  4.50

10.45  3.94

<0.001*

Range of polyp size in mm Max polyp size (mm) mean  SD

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Table 2. The independent risk factors of post- polypectomy bleeding in patients on antiplatelet therapy Variants Size of polyps removed Discontinuation of antiplatelet agents 5-7days before polypectomy

Multivariate analysis Hazzard ratio (95%CI)

p value

1.45(1.10-1.93) 0.12(0.02-0.84)

0.01* 0.03*

* means significant statistic different.

Su1983 Safety and Feasibility of Combination EUS-Guided Portal Pressure Gradient Measurement and Liver Biopsy: The Realization of EndoHepatology Takeshi Tsujino*1, Jason Y. Huang1, Jason B. Samarasena1, Ke-Qin Hu1, Greg C. Miller2, Andrew Clouston2, Kenneth J. Chang1 1 H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, Orange, CA; 2Envoi Specialist Pathology, Kelvin Grove, Queensland, Australia Introduction: Liver biopsy and portal pressure gradient (PPG) measurement are important procedures for the diagnosis and management of patients with liver disease. While liver biopsy is usually performed percutaneously, PPG is indirectly measured via a transjugular approach. EUS-guided liver biopsy is a possible alternative to percutaneous liver biopsy. Recently, we have shown in both animal and human studies that EUS-guided PPG measurement is a potential alternative to the transjugular approach. Aim: To evaluate the safety, feasibility and recovery time of performing both EUS-guided PPG measurement and liver biopsy during the same procedure Methods: Under EUS guidance, the portal vein, hepatic vein, and/or inferior vena cava were punctured using a 25G FNA needle. Then PPG was measured with a non-compressible tubing and a novel compact manometer (Cook Medical, IN, USA). Subsequently, EUS-guided biopsy from the left and/or right liver was performed using a 19G FNA needle. Post-procedure recovery time was compared to that of patients undergoing standard EUS procedure with/without FNA as well as those undergoing conventional percutaneous liver biopsy. Post-procedure complications were evaluated by interviewing in person (on the day of the procedure) and by phone (1 and 7 days after the procedure). The reporting pathologists were blinded to the PPG results. Results: Between Feb 2014 and Nov 2015, 22 patients underwent combination EUS-guided PPG measurement and liver biopsy; the procedure was performed under general anesthesia in all but one patient. Hospitalization for observation was required in one patient with multiple additional procedures. Mean post-procedure recovery time in the remaining 21 patients was 64.5  16.9 min. Otherwise recovery time in patients undergoing standard EUS procedure with/ without FNA or percutaneous liver biopsy was 67.9  25.2 min (p Z 0.9298) and 242.5  35.1 min (p < 0.01), respectively (Figure 1). None of the 22 patients developed bleeding, infection, or perforation. The median pain score prior to

Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB415