B0309 - Risk of GI Bleed Recurrence in Dual Antiplatelet Therapy Compared to Antiplatelet Monotherapy in Patients Who Underwent Double Balloon Enteroscopy at a Tertiary Care Center

Introduction: The decision to initiate dual antiplatelet therapy (DAPT) continues to be the center of an intense multidisciplinary discussion regarding overall risks and benefits with gastrointestinal (GI) bleed as a primary contraindication for initiation or continuation of DAPT. This study seeks to examine the rate of GI bleed following anterograde or retrograde double balloon enteroscopy (DBE) while using DAPT vs monotherapy.

Methods: We conducted a retrospective cohort study of patients (n=1163) who underwent DBE at a tertiary care center between 9/2012 and 12/2020 and reviewed the data for patient demographics, indication for endoscopy, interventions, readmission, and recurrent GI bleed. Patients were further stratified by their use of anti-platelet therapy in absence of concomitant anticoagulant use (n=251). Chi-square and 2 sample t-test were used to compare patient characteristics. Univariate and multivariable logistic regression analysis was implemented to depict adjusted odds ratios (OR) for risk of recurrent GI bleed.

Results: Of the 251 subjects, 58% were male with a mean age of 67.7 (10.25, SD). 71.3% of DBEs were performed as an outpatient. The most common indication for DBE was concern for GI bleed (77%). The mean procedural time was 37.5 (17.6, SD) minutes, and 77.3% of patients underwent anterograde DBE. 42 (17%) patients on DAPT and 209 (83%) patients on monotherapy. A higher proportion of DAPT patients required inpatient admission (50%) compared to monotherapy patients (24%) (p=0.001). GI bleed occurring within 6 months of initial DBE was significantly higher in patients on DAPT (17%) compared to patients on anti-platelet monotherapy (5%) (p=0.009). Univariate logistic regression analysis depicted DAPT and inpatient status to be significantly associated with 6-month GI bleed (both p< 0.05). Following multivariable analysis, DAPT [OR: 2.97, 95% CI (1.04-8.47), p=0.04) remained significantly associated with GI bleed within 6 months post DBE.

Discussion: DBE is often warranted in situations where patients present with obscure GI bleed. Our data indicates that those continued on DAPT have increased incidence of GI bleed at 6 months following DBE when compared with monotherapy. Furthermore, patients using DAPT more frequently required inpatient admission for DBE and were at increased risk for requiring repeat interventions at 6 months. Further studies are needed to confirm our findings.