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; Franco Radaelli; Raza Alikhan; Jean-Marc Dumonceau; Diane Eaton; Jo Jerrome; Will Lester; David Nylander; Mo Thoufeeq; Geoffroy Vanbiervliet; James R. Wilkinson; Jeanin E. van Hooft

doi:10.1055/a-1547-2282

Endoscopy, Table of Contents

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

Guideline

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

Authors

Andrew M. Veitch

¹Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
Franco Radaelli

²Gastroenterology Department, Valduce Hospital, Como, Italy
Raza Alikhan

³Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom
Jean-Marc Dumonceau

⁴Department of Gastroenterology, Charleroi University Hospitals, Charleroi, Belgium
Diane Eaton

⁵Anticoagulation UK, London, United Kingdom
Jo Jerrome

⁶Thrombosis UK, Llanwrda, United Kingdom
Will Lester

⁷Department of Haematology University Hospitals Birmingham NHS Foundation Trust, Birmingham,
David Nylander

⁸Department of Gastroenterology, The Newcastle-upon-Tyne NHS Foundation Trust, Newcastle-upon-Tyne
Mo Thoufeeq

⁹Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
Geoffroy Vanbiervliet

¹⁰Pôle digestif, Hôpital Universitaire L’Archet 2, Nice, France
James R. Wilkinson

¹¹Department of Interventional Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Jeanin E. van Hooft

¹²Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, Netherlands

Abstract

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.

Full Text

References

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