Clinical News

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants

Monday, 15 February 2016 10:45

New BSG/ESGE guideline...

The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage versus thrombosis due to discontinuation of therapy.

P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation); For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation). For highrisk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation).

Warfarin The advice for warfarin is fundamentally unchanged from British Society of Gastroenterology (BSG) 2008 guidance.

Direct Oral Anticoagulants (DOAC) For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation); For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥48 h before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30–50 mL/min we recommend that the last dose of DOAC be taken 72 h before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation).

NICE Quality Standard: Irritable bowel syndrome in adults

Monday, 15 February 2016 13:50

This quality standard covers the diagnosis and management of irritable bowel syndrome in adults. It does not cover other gastrointestinal disorders such as non-ulcer dyspepsia, coeliac disease and inflammatory bowel disease. For more information see the irritable bowel syndrome topic overview.

UK NSC recommendation on Bowel Cancer screening in adults

Tuesday, 19 January 2016 14:45

Following evaluation and consultation, that BSG fed in to, the UK National Screening Committee (NSC) has recommended a change to the test used in the Bowel Cancer Screening Programmes. UK NSC has announced that the use of Faecal Immunochemical Test as the primary test for bowel cancer should replace guaiac Faecal Occult Blood Test. UK NSC has also indicated that as colonoscopy capacity grows or screening uptake increases, the programmes should review and recommend alteration of the cut offs to increase the number of cancers detected.

Do you treat children with Hirschsprung's or Gastroschisis?

Wednesday, 06 January 2016 09:14

Would you be interested in sharing your expertise, improving the quality of research, and helping to improve outcomes in both conditions? NETS (Next stage in Evidence-based paediatric surgical Treatment Strategies), are developing core outcome sets for Hirschsprung's Disease and gastroschisis, and need doctors, nurses, allied health professionals, parents and patients to help us by completing three online questionnaires over the next 6 months. For more information and to register your interest, please go to www.npeu.ox.ac.uk/nets/taking-part

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