Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

C. Boustière; A. Veitch; G. Vanbiervliet; P. Bulois; P. Deprez; A. Laquiere; R. Laugier; G. Lesur; P. Mosler; B. Nalet; B. Napoleon; B. Rembacken; N. Ajzenberg; J. P. Collet; T. Baron; J.-M. Dumonceau

doi:10.1055/s-0030-1256317

Endoscopy 2011; 43(5): 445-461
DOI: 10.1055/s-0030-1256317

Guidelines

Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

C. Boustière¹ , A. Veitch² , G. Vanbiervliet³ , P. Bulois⁴ , P. Deprez⁵ , A. Laquiere¹ , R. Laugier⁶ , G. Lesur⁷ , P. Mosler⁸ , B. Nalet⁹ , B. Napoleon¹⁰ , B. Rembacken¹¹ , N. Ajzenberg¹² , J. P. Collet¹³ , T. Baron¹⁴ , J.-M. Dumonceau¹⁵

¹Department of Digestive Endoscopy, Hôpital Saint Joseph, Marseille, France
²Endoscopy and Bowel Cancer Screening, New Cross Hospital, Wolverhampton, UK
³Department of Gastroenterology and Endoscopy, Hôpital universitaire l’Archet, Nice, France
⁴Service de Pathologie Digestive, Hôpital Saint Philibert, Lomme, France
⁵Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
⁶Department of Gastroenterology and Endoscopy, Hôpital de la Timone, Marseille, France
⁷Department of Digestive Endoscopy, Hôpital Ambroise Paré, Paris, France
⁸Division of Gastroenterology, University of Kentucky Medical Center, Lexington, Kentucky, USA
⁹Department of Gastroenterology, Hôpital de Montélimar, Montélimar, France
¹⁰Department of Endoscopy, Hôpital Jean Mermoz, Lyon, France
¹¹Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK
¹²Département d’Hématologie, AP-HP, Hôpital Bichat, INSERM, U698; Université Paris 7 Denis Diderot, Paris, France
¹³Institut de Cardiologie – INSERM U 937, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
¹⁴Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
¹⁵Service of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland

Abstract

With the increasing use of antiplatelet agents (APA), their management during the periendoscopic period has become a more common and more difficult problem. The increase in use is due to the availability of new drugs and the widespread use of drug-eluting coronary stents. Acute coronary syndromes can occur when APA therapy is withheld for noncardiovascular interventions. Guidelines about APA management during the periendoscopic period are traditionally based on assessments of the procedure-related risk of bleeding and the risk of thrombosis if APA are stopped. New data allow better assessment of these risks, of the necessary duration of APA discontinuation before endoscopy, of the use of alternative procedures (mostly for endoscopic retrograde cholangiopancreatography [ERCP]), and of endoscopic methods that can be used to prevent bleeding (following colonic polypectomy). This guideline makes graded, evidence-based, recommendations for the management of APA for all currently performed endoscopic procedures. A short summary and two Tables are included for quick reference.

Full Text

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J.-M. DumonceauMD, PhD

Service of Gastroenterology and Hepatology
Geneva University Hospitals

Rue Gabrielle-Perret Gentil 4
1211 Genève 14
Switzerland

Fax: +41-22-3729366

Email: jmdumonceau@hotmail.com

Supplementary Material

Appendix