Polyps Clinical Trial
— OPERAOfficial title:
Prospective Observatory of Endoscopic Mucosal Colonic Resection and Polypectomy Under Aspirin : the "OPERA" Study
The endoscopic management of patients on anti platelet agents is a wide problem more and
more common, with prevalence of patients on this type of therapy steadily increasing. The
risk of bleeding on antiplatelet during an endoscopic examination can be major. The risk of
cardiovascular thrombotic accident in dirty shutdown of anti platelet, was recently
described as significant (4-5%). Current recommendations for polypectomy allow the gesture
as aspirin and are based on literature data scarce, often retrospective. Such work may be
for a lack of increased bleeding risk during a colonic polypectomy under aspirin. There is
to date no significant data published on the implementation of the endoscopic mucosal
resection (mucosectomy) under aspirin. It is necessary to achieve a national multicenter
observational study on a large scale in the daily practice of colonic polypectomy /
mucosectomy in patient taking aspirin.
The aim of the study is to determine the incidence of immediate and delayed bleeding colonic
polypectomy and mucosectomy with aspirin. The patients undergoing colonoscopy and taking a
long-term aspirin therapy and presenting a major risk of thromboembolism or medium will
incluables. Inclusion will be achieved for those patients receiving aspirin colonoscopy
after signing a specific consent. Polypectomy will be possible according to the
recommendations of the French Society of Digestive Endoscopy. Upon discovery of a lesion to
be resected by mucosectomy, the patient will benefit from the mucosectomy. The study is
observational, multicenter, prospective, national. The polypectomies / colonic mucosectomies
will be made using the conventional techniques and the current recommendations. The
immediate and delayed hemorrhage meet specific definitional criteria. The number of patients
to be included will be 1000. The duration of the study inclusions will be 36 months. The
trial will be conducted in full compliance with laws, regulations and ethical aspects.
It is expected in this work that the incidence of post-polypectomy bleeding under aspirin is
the same. The rate of bleeding reported in the post mucosectomy size is higher compared to
the polypectomy: it is however expected that the rate of bleeding in the post mucosectomy
with or without aspirin is indifferent. It will follow a recommendation of French society
adapted to endoscopy for this type of procedure
Status | Completed |
Enrollment | 317 |
Est. completion date | October 2012 |
Est. primary completion date | October 2012 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Age = 18 years, male or female - Polypectomy AND / OR mucosectomy (EMR) performed on aspirin during a colonoscopy - Taking a single daily dose of aspirin long-term (<375 mg for more than 3 months) in the prevention of cardiovascular and thromboembolic risk with a major or medium - secondary prevention - Affiliation to the regime of national health protection - Informed consent and patient's written obtained - No participation in another clinical study Exclusion Criteria: - Contraindications to the achievement of a lower gastrointestinal endoscopy - Taking a single daily dose of clopidogrel or other anti-platelet, anti vitamin K (AVK), heparin or anti bi aggregation in the context of cardiovascular prevention - Taking chronic anti inflammatory drug (at least once weekly) - Haemorrhagic disease, disorders of hemostasis and coagulation (PT <60%, aPTT> 40 sec. And platelets <60000/mm3), hematologic malignancy, chronic liver cirrhosis classified as Child Pugh B or C, acute or chronic renal failure - Patient with severe disease and progressive decompensated in the opinion of the investigator - Pregnant women, nursing - Not signing the written consent and / or mental disabilities of the subject making its participation in the trial impossible |
Observational Model: Cohort, Time Perspective: Prospective
Country | Name | City | State |
---|---|---|---|
France | Archet 2 hospital | Nice |
Lead Sponsor | Collaborator |
---|---|
Société Française d'Endoscopie Digestive |
France,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Incidence of delayed bleeding after polypectomy and / or colonic mucosectomy (endoscopic mucosal resection) in patients on aspirin | 30 days | Yes | |
Secondary | Incidence of immediate bleeding after polypectomy and / or colonic mucosectomy in patients on aspirin | one minute | Yes | |
Secondary | Efficacy of endoscopic hemostasis in case of bleeding induced | During the lenght of endoscopy (colonoscopy) and at 30 days | No | |
Secondary | morbidity / mortality induced by immediate and delayed bleeding after polypectomy and / or colonic mucosectomy in patients on aspirin | 30 days | Yes | |
Secondary | predictors of gastrointestinal bleeding post polypectomy / mucosectomy under aspirin by sub groups of patients obtained | 30 days | No |
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