Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature

Table 1 Stratification of endoscopic procedures based on the risk of bleeding according to international guidelines

Procedure risk group	Practice guidelines
	ASGE[3]	ESGE/BSG[4]	APAGE/APSDE[5]
Low-risk	(1) Diagnostic (EGD, colonoscopy, flexible sigmoidoscopy) including mucosal biopsy; (2) ERCP with stent (biliary or pancreatic) placement or papillary balloon dilation without sphincterotomy; (3) Push enteroscopy and diagnostic balloon-assisted enteroscopy; (4) Capsule endoscopy; (5) Enteral stent deployment (controversial); (6) EUS without FNA; (7) Argon plasma coagulation and (8) Barrett’s ablation	(1) Diagnostic procedures +/– biopsy; (2) Biliary or pancreatic stenting; (3) Diagnostic EUS and (4) Device-assisted enteroscopy without polypectomy	(1) Diagnostic endoscopy with biopsy; (2) Endoscopic ultrasound without fine needle aspiration; (3) ERCP with biliary or pancreatic stenting; (4) Diagnostic push or device-assisted enteroscopy; (5) Video capsule endoscopy; (6) Oesophageal, enteral and colonic stenting and (7) Argon plasma coagulation
High-risk	(1) Polypectomy; (2) Biliary or pancreatic sphincterotomy; (3) Treatment of varices; (4) PEG/PEJ placement; (5) Therapeutic balloon-assisted enteroscopy; (6) EUS with FNA; (7) Endoscopic hemostasis; (8) Tumor ablation; (9) Cystgastrostomy; (10) Ampullary resection; (11) EMR; (12) Endoscopic submucosal dissection and (13) Pneumatic or bougie dilation	(1) Polypectomy; (2) ERCP with sphincterotomy; (3) Ampullectomy; (4) EMR; (5) ESD; (6) Dilation of strictures; (7) Therapy of varices; (8) PEG; (9) EUS with FNA and (10) Oesophageal, enteral or colonic stenting	(1) Polypectomy; (2) ERCP with sphincterotomy ± balloon sphincteroplasty; (3) Dilatation of strictures; (4) Injection or banding of varices; (5) PEG/PEJ placement; (6) EUS with FNA and (7) Ampullectomy
Ultra-high-risk	NA	NA	(1) ESD; (2) EMR of large (> 2 cm) polyps

ASGE: American society for gastrointestinal endoscopy; ESGE/BSG: European society of gastrointestinal endoscopy and British society of gastroenterology; APAGE/APSDE: Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy; EGD: Esophagogastroduodenoscopy; EUS: Endoscopic ultrasound; FNA: Fine-needle aspiration; ERCP: Endoscopic retrograde cholangiopancreatography; PEG: Percutaneous endoscopic gastrostomy; PEJ: Percutaneous endoscopic jejunostomy; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; NA: Not assessed.