Editing Peri-endoscopy anticoagulation


== Principles ==

* Use guidelines for reference, but make each decision on a case-by-case basis
* Bleeding is common but rarely life-threatening
* Consider whether the procedure is urgent, or can be deferred until the patient no longer needs anticoagulation

=== Risk of procedure-related bleeding ===

* Anticoagulation has little impact on low-risk procedures:
** Diagnostic gastroscopy, colonoscopy or balloon enteroscopy, including biopsies
** ERCP without sphincterotomy
** EUS without FNA
** Cold snare removal of small polyps
** Capsule endoscopy
* High-risk procedures should be done off anticoagulation:
** Large polypectomy (>1cm)
** EMR or submucosal dissection
** ERCP with sphincterotomy
** EUS with biopsy or therapeutic procedure
** Dilatation by Savary dilator, or balloon dilation
** Coagulation or ablation of tumours or vascular lesions by APC or LASER
** Variceal sclerotherapy

=== Risk of thromboembolism ===

* See 'anticoagulation' under 'perioperative medicine'

=== Restarting anticoagulation ===

* There is little hard data to guide practice
* Sphincterotomy - aim to restart on day 3 post-op, otherwise 10-15% risk of bleeding

[[Category:Endoscopy]]