EFFICACY OF THE GUIDELINES FOR GASTROENTEROLOGICAL ENDOSCOPY IN PATIENTS RECEIVING ANTICOAGULANT TREATMENT

Abstract

In 2017, the Japan Gastroenterological Endoscopy Society (JGES) updated the guidelines for gastroenterological endoscopy in patients receiving antithrombotic treatments, considering the risk of thrombosis and gastrointestinal hemorrhage in patients who are receiving warfarin or one of the three newly available direct oral anticoagulants (DOACs). The guidelines recommend that among patients who are receiving anticoagulants, the endoscopic procedure is performed under continuous administration of warfarin or DOAC in patients who regularly receive the respective anticoagulant, or that the endoscopic procedure is performed under an alternative treatment of heparin or DOAC bridging therapy in patients who regularly receive warfarin. However, conventional heparin bridging therapy has the disadvantage of increasing the risk of gastrointestinal hemorrhage, and the disadvantage of DOAC is that there is no parameter to evaluate the pharmacological efficacy of the DOAC. Therefore, it is important to assess the utility of the guidelines and to establish a system that allows safe endoscopic procedures to be performed in patients who are receiving an anticoagulant such as warfarin or a DOAC.