The incidence of deep vein thrombosis in Japanese patients undergoing endoscopic submucosal dissection

Background: Endoscopic submucosal dissection (ESD) is more invasive than other common endoscopic procedures and may increase the risk for deep vein thrombosis (DVT)/pulmonary embolism. The incidence of DVT/pulmonary embolism after ESD has not been adequately studied.

Objective: To evaluate DVT incidence and disease-specific features of D-dimer levels in ESD patients.

Design: Prospective cohort study.

Setting: Single academic center.

Patients: This study involved 60 patients with superficial gastric neoplasms indicated for ESD.

Intervention: For all patients who underwent ESD, ultrasonography of the lower limbs was performed to detect DVT the day after ESD. D-dimer levels were measured 3 times: before ESD, immediately after ESD, and the day after ESD.

Main outcome measurements: DVT incidence after ESD.

Results: The DVT incidence was 10.0% (6/60). At all 3 time points, D-dimer measurements were higher in patients with DVT than in patients without DVT. According to receiver operating characteristic curve analysis, the resulting cut-off value of the D-dimer level the day after ESD was 1.9 μg/mL (sensitivity 83.3%; specificity 79.6%) for ESD patients, with superior association to pre-ESD or immediately after ESD. In univariate analyses, high D-dimer levels the day after ESD and the presence of comorbidities were significantly associated with DVT development.

Limitations: Single center and small number of patients.

Conclusion: ESD procedures have a moderate risk for venous thromboembolism. In patients undergoing ESD, D-dimer levels, especially on the day after ESD, may have specific features associated with DVT development.