Guidelines 445

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

Authors 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

Institutions Institutions are listed at the end of article.

submitted With the increasing use of antiplatelet agents stopped. New data allow better assessment of 15 December 2010 (APA), their management during the periendo- these risks, of the necessary duration of APA dis- accepted after revision scopic period has become a more common and continuation before endoscopy, of the use of alter- 21 December 2010 more difficult problem. The increase in use is native procedures (mostly for endoscopic retro- Bibliography due to the availability of new drugs and the wide- grade cholangiopancreatography [ERCP]), and of DOI http://dx.doi.org/ spread use of drug-eluting coronary stents. Acute endoscopic methods that can be used to prevent 10.1055/s-0030-1256317 coronary syndromes can occur when APA therapy bleeding (following colonic polypectomy). This Endoscopy 2011; 43: is withheld for noncardiovascular interventions. guideline makes graded, evidence-based, recom- 445–458 © Georg Thieme Guidelines about APA management during the mendations for the management of APA for all Verlag KG Stuttgart · New York periendoscopic period are traditionally based on currently performed endoscopic procedures. A ISSN 0013-726X assessments of the procedure-related risk of short summary and two Tables are included for Corresponding author bleeding and the risk of thrombosis if APA are quick reference. J.-M. Dumonceau, MD, PhD Service of and 1. Introduction In this Guideline, the current evidence is re- Hepatology ! Geneva University Hospitals viewed and recommendations made for the man- Rue Gabrielle-Perret Gentil 4 Antiplatelet agents (APA) reduce the aggregation agement of APA therapy in patients undergoing 1211 Genève 14 of platelets and are commonly used in patients endoscopic procedures. Switzerland with coronary heart disease, peripheral arterio- Fax: +41-22-3729366 pathy, and cardiac arrhythmias. Coronary heart [email protected] disease represents the most frequent indication 2. Methods because there is a risk of coronary stent occlusion ! which requires continuous treatment with APA. The European Society of Gastrointestinal Endos- The risk of stent occlusion is most important in copy (ESGE) commissioned and funded this the immediate post-stent placement period. Guideline, which was based on preparatory work There are varying levels of thrombotic risk de- performed by the French Society of Digestive pending on the type of stent placed (bare or Endoscopy. The process was similar to that used drug-eluting stent) as well as other risk factors in creating other ESGE guidelines [4]. It included [1]. Conditions that require APA therapy as well face-to-face meetings, teleconferences, and elec- as the modalities of APA administration have re- tronic-based discussions among subgroups and cently been updated in guidelines issued by the members of the entire committee during 2010. European Society of Cardiology and the European Subgroups were formed, each of which was Association for Cardio-Thoracic [2]. charged with a series of clearly defined key ques- The discontinuation of APA therapy in patients tions (see Appendix e1, available online). The undergoing a noncardiovascular intervention ac- committee chair worked with subgroup leaders counts for approximately 5% of hospitalizations to identify pertinent search terms (see Appendix for acute coronary syndrome. Therefore, perien- e2, available online). Searches of Medline (via doscopic management of patients with a high Pubmed), the Cochrane Library, Embase, and the thrombot