Author response to letter: colonic stenting in patients on P2Y12 receptor antagonists and direct oral anticoagulants--are current BSG/ESGE guidelines practical?

We thank the authors for their interest in the recently published British Society of Gastroenterology and European Society of Gastrointestinal Endoscopy (ESGE) guidelines on endoscopy in patients on antiplatelet or anticoagulant therapy.1 As stated in the summary of recommendations, these guidelines refer to the management of elective endoscopic procedures. For elective palliative colonic stenting, there is often adequate time to discontinue antithrombotic therapy, including P2Y12 antagonists. In an emergency situation, we agree with the authors that the balance of risk between haemorrhage due to stenting versus death due to colonic obstruction would favour endoscopic stenting. Importantly, stenting in this context is controversial, and ESGE guidelines recommend this only for those at high risk of postoperative mortality.2 The patient should be consented accordingly in this high-risk situation. We are also grateful to the authors for highlighting the potential use of idarucizumab as a reversal agent for...

Source: Gut - February 14, 2017 Category: Gastroenterology Authors: Veitch, A., Dumonceau, J.-M. Tags: PostScript Source Type: research