CC BY-NC 4.0 · Endoscopy 2021; 53(09): 947-969
DOI: 10.1055/a-1547-2282

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Andrew M. Veitch
 1  Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
Franco Radaelli
 2  Gastroenterology Department, Valduce Hospital, Como, Italy
Raza Alikhan
 3  Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom
 4  Department of Gastroenterology, Charleroi University Hospitals, Charleroi, Belgium
Diane Eaton
 5  Anticoagulation UK, London, United Kingdom
Jo Jerrome
 6  Thrombosis UK, Llanwrda, United Kingdom
Will Lester
 7  Department of Haematology University Hospitals Birmingham NHS Foundation Trust, Birmingham,
David Nylander
 8  Department of Gastroenterology, The Newcastle-upon-Tyne NHS Foundation Trust, Newcastle-upon-Tyne
Mo Thoufeeq
 9  Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
Geoffroy Vanbiervliet
10  Pôle digestif, Hôpital Universitaire L’Archet 2, Nice, France
James R. Wilkinson
11  Department of Interventional Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Jeanin E. van Hooft
12  Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, Netherlands
› Author Affiliations


This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

Supplementary material

Publication History

Publication Date:
06 August 2021 (online)

© 2021. European Society of Gastrointestinal Endoscopy, British Society of Gastroenterology, the Author(s) or their employer(s). This is an open access article published by Thieme and BMJ Publishing Group Ltd under the terms of the Creative Commons Attribution Non Commercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (

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