Colonic stenting in patients on P2Y12 receptor antagonists and direct oral anticoagulants: are current BSG/ESGE guidelines practical?

We thank the British Society of Gastroenterology and the European Society of Gastrointestinal Endoscopy for updating guidelines relating to endoscopy in patients on antiplatelets or anticoagulation therapy.1 However, we wish to raise two important issues. First, this guideline recommends deferring colonic stent placement in patients on P2Y12 receptor antagonists until it is discontinued for at least 5 days. However, malignant colonic obstruction (unlike oesophageal or pyloric obstruction) is an emergency, which if not dealt with immediately could potentially result in serious adverse events. Self-expanding mesh stent (SEMS) insertion is a feasible alternative to emergency surgery in selected patients with malignant colonic obstruction. The risks of bleeding secondary to an appropriately placed colonic SEMS are low and this is referred to within the guidelines. It would be unsafe to delay colonic SEMS insertion in patients who are on P2Y12 receptor antagonist. Second, there remains the potential to use idarucizumab...

Source: Gut - January 5, 2017 Category: Gastroenterology Authors: Murugesan, S. V. M., Hendrickse, M. T. Tags: PostScript Source Type: research