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Keywords:

  • aspirin;
  • endoscopic biopsy;
  • endoscopic mucosal resection;
  • endoscopic submucosal dissection;
  • warfarin

Abstract

Background:  A guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures has been established from Japan Gastroenterological Endoscopy Society in 2005. However, it is unknown whether consensus on the management of these conditions is obtained among endoscopists in daily practice owing to the guideline.

Methods:  To study the current practice on the management, survey questionnaires were sent to 13 representative endoscopists of 13 middle or high-volume hospitals in the Tokyo area.

Results:  Responses were obtained from all 13 endoscopists. The results showed that only five (38%) and six (46%) hospitals had their own standard protocols regarding the management for endoscopic biopsy and endoscopic mucosal resection (EMR), respectively. There was a wide variation among endoscopists in terms of discontinuation of each agent. When the patients had a major risk of thromboembolism due to discontinuation of anticoagulants and antiplatelet agents, seven (54%) and five (38%) endoscopists, respectively, never took a biopsy. Similar numbers of endoscopists never carried out EMR. During discontinuation of anticoagulants or antiplatelet agents for biopsy and EMR, three (23%) and three (23%) endoscopists, respectively, experienced patients with thromboembolic events.

Conclusions:  There is still a wide variation and confusion among endoscopists after establishment of our national guideline. A robust national guideline with clearer description based on the scientific evidence is needed.