Do antiplatelet agents increase hemorrhagic risk from endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions?

[Background] Japan Gastroenterological Endoscopy Society (JGES) guidelines for antithrombotic agents and endoscopy, which were revised in 2012, recommend the continuation of aspirin (ASA) or cilostazol (CLZ) during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with a high risk of thromboembolism. In this study to evaluate the effectiveness of the new guidelines, we investigated hemorrhagic complications of EUS-FNA of pancreatic lesions in patients taking ASA or CLZ. [Patients and Methods] We retrospectively analyzed 154 consecutive patients who underwent EUS-FNA of pancreatic lesions in our hospital between October 2010 and February 2014. Of these patients, 118 (76.6%) did not take any anticoagulant or antiplatelet agents, 16 (10.4%) had taken some anticoagulant and/or antiplatelet agents but stopped taking the drugs before EUS-FNA, and 20 (13.0%) patients had taken antiplatelet agents and continued taking ASA or CLZ. [Results] A little hemorrhaging occurred into the gastro-intestinal lumen or pancreatic duct, or around the pancreas in 3 (2.5%), 0 (0%), and 1 (5.0%) of each group, respectively, during the course of EUS-FNA. There was no significant difference in the rate of hemorrhage between the three groups. Serious hemorrhaging after EUS-FNA was not observed in any patient. [Conclusion] These findings indicate that, as stated in the revised guidelines, the continuous use of ASA or CLZ does not increase hemorrhagic risk during and after EUS-FNA of pancreatic lesions.