Anticoagulation and antiplatelet management in gastrointestinal endoscopy: A review of current evidence

Table 1 Diagnostic endoscopy and colonoscopy with biopsy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Fujita et al[5]	2015	Japan	Retrospective	3671	Endoscopic biopsy	No medications	Incidence of PPB 0.98%
Ara et al[6]	2015	Japan	Prospective	3758	Endoscopic biopsy	No medications	Incidence of PPB 0.12%
Yuki et al[7]	2017	Japan	Prospective	263	Endoscopic biopsy	No medications	No incidence of PPB

PPB: Post-procedural bleeding.

Table 2 Diagnostic ± therapeutic push or device assisted enteroscopy/balloon enteroscopy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Yamamoto et al[8]	2015	Japan	Prospective	120	DBE	No medications	No incidence of PPB
Wang et al[9]	2020	Japan	Retrospective	1531	DBE	No medications	Incidence of PPB 0.5%

DBE: Double balloon enteroscopy; PPB: Post-procedural bleeding.

Table 3 Endoscopic ultrasound ± fine needle aspiration

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Song et al[18]	2010	South Korea	Prospective	117	EUS + FNA	No medications	No incidence of PPB
Uehara et al[10]	2011	Japan	Retrospective	115	EUS + FNA	No medications	No incidence of PPB
Suzuki et al[11]	2012	United States	Prospective	20	EUS + FNA	No medications	No incidence of PPB
Lee et al[12]	2013	South Korea	Prospective	188	EUS + FNA	No medications	Incidence of PPB 2.1% (25G group). Incidence of PPB 4.3% (22G group)
Vilmann et al[13]	2013	Denmark	Prospective	135	EUS - FNA	No medications	No incidence of PPB
Yang et al[14]	2015	South Korea	Retrospective	76	EUS + FNA	No medications	No incidence of PPB
Mavrogenis et al[15]	2015	United States	Prospective	28	EUS + FNA	No medications	No incidence of PPB
Ramesh et al[19]	2015	South Korea	Prospective	100	EUS + FNA	No medications	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 1.0%
Park et al[16]	2016	Denmark	Prospective	56	EUS + FNA	No medications	No incidence of PPB
Inoue et al[17]	2017	Japan	Retrospective	742	EUS + FNA	No medications	No incidence of PPB
Iwashita et al[20]	2018	South Korea	Prospective	110	EUS + FNA	No medications	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 1.8%

EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; PPB: Post-procedural bleeding.

Table 4 Endoscopic retrograde cholangiopancreatography (diagnostic)

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Masci et al[21]	2001	Italy	Prospective	782	ERCP (diagnostic)	No medications	Incidence of PPB 1.13%
Williams et al[22]	2007	United Kingdom	Prospective	5264	ERCP (diagnostic)	No medications	Incidence of PPB 0.9%
Cotton et al[23]	2009	United States	Retrospective	11497	ERCP (diagnostic)	No medications	Incidence of PPB 0.3%
Coelho-Prabhu et al[24]	2013	United States	Retrospective	1072	ERCP (diagnostic)	No medications	Incidence of PPB 1.4%
Rotundo et al[25]	2020	United States	Retrospective	555	ERCP (diagnostic)	No medications	Incidence of PPB 1.66% (teaching hospital). Incidence of PPB 1.49% (nonteaching hospital)

ERCP: Endoscopic retrograde cholangiopancreatography; PPB: Post-procedural bleeding.

Table 5 Conventional polypectomy/hot snare polypectomy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Gupta et al[26]	2012	United Kingdom	Prospective	1200	Polypectomy	No medications	Incidence of PPB 0.67%
Paspatis et al[27]	2011	Greece	Prospective	18	Polypectomy	No medications	No incidence of PPB
Singh et al[28]	2010	United States	Retrospective	1243	Polypectomy	No medications	Incidence of PPB 1%
Sewitch et al[29]	2012	Canada	Prospective	2134	Polypectomy	No medications	Incidence of PPB 0.05%
Feagins et al[30]	2011	United States	Retrospective	1849	Polypectomy	No medications	Incidence of PPB 0.32%
Pan et al[31]	2012	New Zealand	Retrospective	348	Polypectomy	No medications	Incidence of PPB 0.86%
Manocha et al[32]	2012	United States	Retrospective	672	Polypectomy	No medications	Incidence of PPB 3.0%
Kim et al[33]	2013	South Korea	Retrospective	7447	Polypectomy	No medications	Incidence of PPB 1.3%
Gavin et al[34]	2013	United States	Prospective	20085	Polypectomy	No medications	Incidence of PPB 0.26%
Rutter et al[35]	2014	United Kingdom	Retrospective	167208	Polypectomy	No medications	Incidence of PPB 0.65%
Choung et al[36]	2014	South Korea	Retrospective	5981	Polypectomy	No medications	Incidence of PPB 1.1%
Gómez et al[37]	2015	United States	Prospective	18	Polypectomy	No medications	No incidence of PPB
Suzuki et al[38]	2018	Japan	Prospective	27	Polypectomy	No medications	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 3.5%
Kawamura et al[39]	2018	Japan	Prospective	402	Polypectomy	No medications	Incidence of PPB 0.5%
Ket et al[40]	2020	Australia	Retrospective	258	Polypectomy	No medications	Incidence of PPB 3.5%
Kishida et al[41]	2019	Japan	Retrospective	5381	Polypectomy	No medications	Incidence of PPB 0.7%

PPB: Post-procedural bleeding.

Table 6 Cold snare polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Paspatis et al[27]	2011	Greece	Prospective	530	Polyp size 3-8 mm	CSP	No medications	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 9.1%
Ichise et al[44]	2011	Japan	Prospective	101	Polyp size < 8 mm	CSP	No medications	No incidence of PPB
Gómez et al[37]	2015	United States	Prospective	21	Polyp size < 6 mm	CSP	No medications	No incidence of PPB
Choksi et al[51]	2015	United States	Retrospective	15	Polyp size ≥ 10 mm	CSP	No medications	No incidence of PPB
Muniraj et al[52]	2015	United States	Retrospective	12	Polyp size ≥ 10 mm	CSP	No medications	No incidence of PPB
Piraka et al[53]	2017	United States	Retrospective	94	Polyp size ≥ 10 mm	CSP	No medications	No incidence of PPB
Hirose et al[54]	2017	Japan	Retrospective	125	Polyp size ≥ 10 mm	CSP	No medications	No incidence of PPB
Tutticci et al[55]	2018	Australia	Prospective	163	Polyp size ≥ 10 mm	CSP	No medications	No incidence of PPB
Zhang et al[48]	2018	China	Prospective	212	Polyp size 6-9 mm	CSP	No medications	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 2.7%
Suzuki et al[38]	2018	Japan	Prospective	25	Polyp size ≤ 10 mm	CSP	No medications	No incidence of PPB
Kawamura et al[39]	2018	Japan	Prospective	394	Polyp size 4-9 mm	CSP	No medications	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 7.1%
Ket et al[40]	2020	Australia	Retrospective	346	Polyp size 10-20 mm	CSP	No medications	No incidence of PPB

CSP: Cold snare polypectomy; PPB: Post-procedural bleeding.

Table 7 Endoscopic mucosal resection

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Zhang et al[48]	2018	China	Prospective	203	Polyp size 6-9 mm	EMR	No medications	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 1.7%
So et al[50]	2019	South Korea	Retrospective	798	Mean polyp size 34 mm	EMR	No medications	Incidence of PPB 6.3%
Kim et al[49]	2019	South Korea	Retrospective	717	Polyp size ≥ 6 mm to < 20 mm	EMR	No medications	Incidence of PPB 1.7%

EMR: Endoscopic mucosal resection; PPB: Post-procedural bleeding.

Table 8 Endoscopic submucosal dissection

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Igarashi et al[56]	2017	Japan	Retrospective	722	Gastric ESD	No medications	Incidence of PPB 4.2%
Sato et al[57]	2017	Japan	Retrospective	2488	Gastric ESD	No medications	Incidence of PPB 3.9%
Kono et al[58]	2018	Japan	Retrospective	814	Gastric ESD	No medications	Incidence of PPB 5.3%
Arimoto et al[59]	2018	Japan	Retrospective	783	Colorectal ESD	No medications	Incidence of PPB 3.3%
Yamashita et al[60]	2018	Japan	Retrospective	698	Colorectal ESD	No medications	Incidence of PPB 2.7%
Harada et al[61]	2020	Japan	Retrospective	286	Colorectal ESD	No medications	Incidence of PPB 6.6%
Manta et al[62]	2020	Italy	Retrospective	296	Gastric ESD	No medications	Incidence of PPB 10.1%
Chen et al[63]	2020	China	Retrospective	82	Gastric ESD	No medications	Incidence of PPB 3.7%

ESD: Endoscopic submucosal dissection; PPB: Post-procedural bleeding.

Table 9 Endoscopic retrograde cholangiopancreatography with sphincterotomy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Freeman et al[64]	1996	United States and Canada	Prospective	2347	ERCP + sphincterotomy	No medications	Incidence of PPB 2%
Masci et al[21]	2001	Italy	Prospective	1662	ERCP + sphincterotomy	No medications	Incidence of PPB 0.7%. Incidence of immediate PPB 1.1%
Tzovaras et al[65]	2012	Greece	Prospective	50	ERCP + sphincterotomy	No medications	Incidence of PPB 2%
Patai et al[66]	2014	Hungary	Prospective	242	ERCP + sphincterotomy	No medications	Incidence of delayed PPB 6.3%. Incidence of immediate/intraprocedural bleeding 2.7%
Tanaka et al[67]	2015	Japan	Prospective	360	ERCP + sphincterotomy	No medications	Incidence of PPB 9.9%
Ikarashi et al[68]	2017	Japan	Retrospective	816	ERCP + sphincterotomy	No medications	Incidence of PPB 2.2%
Bae et al[69]	2019	South Korea	Retrospective	1121	ERCP + sphincterotomy	No medications	Incidence of delayed PPB 1.2%. Incidence of immediate/intraprocedural PPB 8.5%
Lima et al[70]	2020	Brazil	Prospective	2137	ERCP + sphincterotomy	No medications	Incidence of PPB 2.2%
Yan et al[71]	2020	China	Retrospective	8477	ERCP + sphincterotomy	No medications	Incidence of PPB 1.6%

ERCP: Endoscopic retrograde cholangiopancreatography; PPB: Post-procedural bleeding.

Table 10 Ampullectomy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Hopper et al[72]	2010	Australia	Prospective	10	Ampullectomy	No medications	Incidence of PPB 30%
Harano et al[73]	2011	Japan	Retrospective	28	Ampullectomy	No medications	Incidence of PPB 18%
Patel et al[74]	2011	United States	Retrospective	38	Ampullectomy	No medications	Incidence of PPB 5.3%
Salmi et al[75]	2012	France	Prospective	61	Ampullectomy	No medications	Incidence of PPB 4.9%
Laleman et al[76]	2013	Belgium	Retrospective	91	Ampullectomy	No medications	Incidence of PPB 12.1%
Attila et al[77]	2018	Turkey	Retrospective	44	Ampullectomy	No medications	Incidence of PPB 6.8%
Van Der Wiel et al[78]	2019	Netherlands	Retrospective	87	Ampullectomy	No medications	Incidence of PPB 12.6%
Alali et al[79]	2020	Canada	Retrospective	103	Ampullectomy	No medications	Incidence of PPB 21.4%

PPB: Post-procedural bleeding.

Table 11 Endoscopic dilatation

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Schoepfer et al[80]	2010	United States	Prospective	207	Dilatation (EoE)	No medications	No incidence of PPB
Ally et al[81]	2013	United States	Retrospective	66	Dilatation (EoE)	No medications	No incidence of PPB
Jung et al[82]	2011	South Korea	Retrospective	293	Dilatation (EoE)	No medications	Incidence of PPB 0.3%
Dellon et al[83]	2010	United States	Retrospective	70	Dilatation (EoE)	No medications	No incidence of PPB

EoE: Eosinophilic oesophagitis; PPB: Post-procedural bleeding.

Table 12 Colonic stenting

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Meisner et al[85]	2011	Denmark	Prospective	439	Colonic stent	No medications	Incidence of PPB 0.5%
van Hooft et al[86]	2011	Netherlands	Prospective	47	Colonic stent	No medications	No incidence of PPB
Yoon et al[87]	2011	South Korea	Retrospective	373	Colonic stent	No medications	Incidence of PPB 0.3%
Gianotti et al[88]	2013	Italy	Prospective	81	Colonic stent	No medications	Incidence of PPB 3.7%

PPB: Post-procedural bleeding.

Table 13 Enteral stenting

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Costamagna et al[89]	2012	Italy	Prospective	202	Duodenal stent	No medications	Incidence of PPB 3%

PPB: Post-procedural bleeding.

Table 14 Oesophageal stenting

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Oh et al[90]	2014	South Korea	Retrospective	1485	Oesophageal stent	No medications	Incidence of PPB 1.7%
Liu et al[91]	2016	China	Retrospective	519	Oesophageal stent	No medications	Incidence of PPB 10.4%

PPB: Post-procedural bleeding.

Table 15 Endoscopic cystogastrostromy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Varadarajulu et al[92]	2008	United States	Retrospective	20	ECG	No medications	No incidence of PPB
Melman et al[97]	2009	United States	Prospective	45	ECG	No medications	Incidence of PPB 4.4%
Johnson et al[93]	2009	United States	Retrospective	24	ECG	No medications	Incidence of PPB 8.3%
Varadarajulu et al[96]	2013	United States	Prospective	20	ECG	No medications	No incidence of PPB
Saul et al[94]	2016	United States	Retrospective	21	ECG	No medications	Incidence of PPB 9.5%
Saluja et al[95]	2019	India	Retrospective	35	ECG	No medications	Incidence of PPB 2.9%

ECG: Endoscopic cystogastrostomy; PPB: Post-procedural bleeding.

Table 16 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Singh et al[98]	2012	United States	Retrospective	1541	PEG	No medications	Incidence of PPB 2.7%
Lozoya-González et al[99]	2012	Mexico	Retrospective	40	PEG	No medications	No incidence of PPB

PEG: Percutaneous endoscopic gastrostomy; PPB: Post-procedural bleeding.

Table 17 Diagnostic endoscopy and colonoscopy with biopsy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Whitson et al[103]	2011	United States	Prospective	280	Endoscopic biopsy	Aspirin (continued)	Incidence of bleeding 0.4%
Ono et al[104]	2012	Japan	Prospective	101	Endoscopic biopsy	Aspirin (continued)	No Incidence of PPB
Ara et al[6]	2015	Japan	Prospective	3758	Endoscopic biopsy	Aspirin (continued)	No incidence of PPB
Fujita et al[5]	2015	Japan	Retrospective	105	Endoscopic biopsy	Aspirin (continued)	Incidence of PPB 0.95%
Yuki et al[7]	2017	Japan	Prospective	560	Endoscopic biopsy	Aspirin (continued)	No incidence of PPB
Kono et al[105]	2017	Japan	Prospective	221	Endoscopic biopsy	Aspirin (continued)	No incidence of PPB

PPB: Post-procedural bleeding.

Table 18 Endoscopic ultrasound ± fine needle aspiration

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Inoue et al[17]	2017	Japan	Retrospective	742	EUS + FNA	Aspirin either:(1) Continued (high-risk conditions); (2) Ceased 3 d before	No incidence of PPB
Kawakubo et al[106]	2018	Japan	Prospective	85	EUS + FNA	Aspirin(continued)	No incidence of PPB

EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; PPB: Post-procedural bleeding.

Table 19 Polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Pan et al[31]	2012	New Zealand	Retrospective	145	Size: 2-40 mm (average size 9.6 mm)	Polypectomy	Aspirin (continued)	Incidence of PPB 5.5%
Manocha et al[32]	2012	United States	Retrospective	502	Size: 2-50 mm	Polypectomy	Aspirin (continued)	Incidence of PPB 3.2%
Park et al[43]	2018	South Korea	Prospective	3887	Size: < 10 mm and ≥ 10 mm	Polypectomy	Aspirin (ceased 5-7 d before and restarted 1 d after)	Incidence of PPB 3.4%
Lin et al[107]	2018	United States	Retrospective	20374	Size: < 20 mm and ≥ 20 mm	Polypectomy	Aspirin (continuation or cessation N/S)	Incidence of PPB 0.92%
Kishida et al[41]	2019	Japan	Retrospective	12876	Size: < 10 mm and ≥ 10 mm	Polypectomy	Aspirin either: (1) Ceased 3-5 d before (cases before 2012); (2) Continued (cases after 2012)	Incidence of PPB 0.6%
Amato et al[108]	2019	Italy	Prospective	1504	Size: ≥ 10 mm	Polypectomy	Aspirin (ceased up to 9 d before)	Incidence PPB 4.2%
Watanabe et al[109]	2020	Japan	Retrospective	1050	Size: < 10 mm and ≥ 10 mm	Polypectomy	Aspirin (continued)	Incidence of PPB 4.3%

PPB: Post-procedural bleeding; N/S: Not stated.

Table 20 Cold snare polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Makino et al[110]	2018	Japan	Prospective	33	Size: ≤ 10 mm	CSP	Aspirin (continued)	No incidence of PPB
Arimoto et al[111]	2019	Japan	Retrospective	501	Size: ≤ 10 mm	CSP	Aspirin (continued)	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 9.8%
Won et al[112]	2019	South Korea	Prospective	43	Size: ≤ 10mm	CSP	Aspirin (continued)	No incidence of PPB. Incidence of immediate/intraprocedural bleeding 2.2%

CSP: Cold snare polypectomy; PPB: Post-procedural bleeding.

Table 21 Endoscopic mucosal resection

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Ono et al[113]	2019	Japan	Retrospective	1734	Size: Median size 8.5-9.5 ± 5 mm	EMR	Aspirin (continuation or ceased 3 d before)	Incidence of PPB per polyp resection 1.35% (P = 0.81) on antiplatelet therapy (study limited by not differentiating between aspirin vs thienopyridine)
So et al[50]	2019	South Korea	Retrospective	399	Size: Mean lesion size 34 mm	EMR	Aspirin (ceased day of procedure or 0-4 d before or ceased 5-7 d before or ceased 8-14 d before procedure)	Incidence of PBB 8.2% (either aspirin or thienopyridine monotherapy)
Albéniz et al[114]	2020	Spain	Prospective	1034	Size: ≥ 20 mm (mean size 30.5 mm)	EMR	Aspirin (cessation dependent on comorbidities)	Study expressed risk of PPB on antiplatelet monotherapy as OR: 2.51, 95%CI: 0.99-6.34, P < 0.001 (either aspirin or thienopyridine monotherapy)

OR: Odds ratio; EMR: Endoscopic mucosal resection; PPB: Post-procedural bleeding.

Table 22 Endoscopic submucosal dissection

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Igarashi et al[56]	2017	Japan	Retrospective	367	Gastric ESD	Aspirin (continued)	Incidence of PPB 12.1%
Furuhata et al[115]	2017	Japan	Retrospective	15	Gastric ESD	Aspirin (continued or ceased 3-5 d before)	Incidence of PPB 6.7%
Sato et al[57]	2017	Japan	Retrospective	211	Gastric ESD	Aspirin (continued)	Incidence of PPB 5.7%
Kono et al[58]	2018	Japan	Retrospective	23	Gastric ESD	Aspirin (continued)	Incidence of PPB 21.7%
Arimoto et al[59]	2018	Japan	Retrospective	26	Colorectal ESD	Aspirin (continued)	No incidence of PPB
Oh et al[116]	2018	South Korea	Retrospective	94	Gastric ESD	Aspirin either: (1) Ceased 0-4 d before; (2) Ceased 5-7 d before	Incidence of PPB 12.8%
Harada et al[117]	2019	Japan	Retrospective	56	Gastric ESD	Aspirin (continued)	Incidence of PPB 10.7%
Nam et al[118]	2019	South Korea	Retrospective	31	Gastric ESD	Aspirin (ceased 7 d before)	Incidence of PPB 22.6%
Horikawa et al[119]	2019	Japan	Retrospective	50	Gastric ESD	Aspirin (continued)	Incidence of PPB 2.0%

ESD: Endoscopic submucosal dissection; PPB: Post-procedural bleeding.

Table 23 Endoscopic retrograde cholangiopancreatography with sphincterotomy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Onal et al[120]	2013	Turkey	Prospective	35	Sphincterotomy	Aspirin (within 24 h)	Incidence of PPB 10%
Patai et al[66]	2014	Hungary	Prospective	87	Sphincterotomy	Aspirin (continued)	Incidence of delayed PPB 5.8%. Incidence of immediate/intraprocedural bleeding 4.6%
Ikarashi et al[68]	2017	Japan	Retrospective	1113	Sphincterotomy	Aspirin (continued)	Incidence of PPB 1.8%
Oh et al[121]	2018	United States	Prospective	256	Sphincterotomy	Aspirin (continued)	Incidence of PPB 4.7%
Yamamiya et al[122]	2019	Japan	Retrospective	76	Sphincterotomy	Aspirin either: (1) Continued (low-risk conditions); (2) Ceased 3-5 d before (high-risk conditions)	No incidence of PPB in either continuous or cessation group

PPB: Post-procedural bleeding.

Table 24 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Richter et al[124]	2011	United States	Retrospective	990	PEG	Aspirin (continued)	Incidence of PPB: (1) ≤ 48 h post-PEG 2.2%; (2) > 48 h post-PEG 1.7%
Singh et al[98]	2012	United States	Retrospective	1541	PEG	Aspirin (continued)	Incidence of PPB 3.9%
Lozoya-González et al[99]	2012	Mexico	Retrospective	27	PEG	Aspirin (ceased 1-3 d before)	No incidence of PPB
Lee et al[123]	2013	South Korea	Retrospective	151	PEG	Aspirin (continued)	No incidence of PPB

PEG: Percutaneous endoscopic gastrostomy; PPB: Post-procedural bleeding.

Table 25 Diagnostic endoscopy and colonoscopy with biopsy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Whitson et al[103]	2011	United States	Prospective	350	Endoscopic biopsy	Thienopyridine (continued)	No incidence of PPB
Ono et al[104]	2012	Japan	Prospective	101	Endoscopic biopsy	Thienopyridine (continued)	No incidence of PPB
Ara et al[6]	2015	Japan	Prospective	3758	Endoscopic biopsy	Thienopyridine either: (1) Continued; (2) Ceased 5-7 d before	No incidence of PPB in either group
Fujita et al[5]	2015	Japan	Retrospective	28	Endoscopic biopsy	Thienopyridine (continued)	No incidence of PPB
Yuki et al[7]	2017	Japan	Prospective	560	Endoscopic biopsy	Thienopyridine (continued)	No incidence of PPB
Kono et al[105]	2017	Japan	Prospective	221	Endoscopic biopsy	Thienopyridine (continued)	No incidence of PPB

PPB: Post-procedural bleeding.

Table 26 Endoscopic ultrasound ± fine needle aspiration

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Inoue et al[17]	2017	Japan	Retrospective	742	EUS + FNA	Thienopyridines (ceased 5 d before)	No incidence of PPB
Kawakubo et al[106]	2018	Japan	Prospective	30	EUS + FN	Thienopyridines (ceased 5 d before)	No incidence of PPB

EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; PPB: Post-procedural bleeding.

Table 27 Polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Singh et al[28]	2010	United States	Retrospective	142	Size: < 5 mm or ≥ 10 mm	Polypectomy	Thienopyridine (continued)	Incidence of PPB 3.5%
Feagins et al[30]	2011	United States	Retrospective	118	Size: < 20 mm and > 20 mm (average 7 mm)	Polypectomy	Thienopyridine (continued)	No incidence of PPB
Feagins et al[125]	2013	United States	Prospective	219	Size: Average 5.2 mm	Polypectomy	Thienopyridine (continued)	Incidence of PPB 2.4%
Lin et al[107]	2018	United States	Retrospective	20374	Size: < 20 mm or ≥ 20 mm	Polypectomy	Thienopyridine (ceased 5-7 d before)	Incidence of PPB 0.84%
Kishida et al[41]	2019	Japan	Retrospective	12876	Size: < 10 mm or ≥ 10 mm	Polypectomy	Thienopyridine (ceased 5-7 d before)	Incidence of PPB 0.6%
Amato et al[108]	2019	Italy	Prospective	1648	Size: ≥ 10 mm	Polypectomy	Thienopyridine (ceased 6 d before)	Incidence of PPB 4.2%
Chan et al[126]	2019	China (Hong Kong)	Prospective	216	Size: < 10 mm or ≥ 10 mm (mean size 4.7 mm)	Polypectomy	Thienopyridine (continued)	Incidence of PPB 3.8%
Yu et al[127]	2019	United States	Retrospective	6443	N/S	Polypectomy	Thienopyridine (cessation timing N/S)	Incidence of PPB 0.9%
Watanabe et al[109]	2020	Japan	Retrospective	45	Size: < 10 mm or ≥ 10 mm	Polypectomy	Thienopyridine (cessation timing N/S)	Incidence of PPB 6.7%

N/S: Not stated; PPB: Post-procedural bleeding.

Table 28 Cold snare polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Makino et al[110]	2018	Japan	Prospective	24	Size: ≤ 10 mm	CSP	Thienopyridine (continued)	No incidence of PPB
Arimoto et al[111]	2019	Japan	Retrospective	516	Size: ≤ 10 mm	CSP	Thienopyridine (continued)	No incidence of PPB

CSP: Cold snare polypectomy; PPB: Post-procedural bleeding.

Table 29 Endoscopic mucosal resection

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Ono et al[113]	2019	Japan	Retrospective	1734	Size: Median size 8.5-9.5 ± 5 mm	EMR	Thienopyridines (ceased 3-5 d before)	Incidence of PPB 1.35%
So et al[50]	2019	South Korea	Retrospective	399	Size: Mean lesion size 34 mm	EMR (and ESD)	Thienopyridines either: (1) Ceased day of procedure; (2) 0-4 d before; (3) Ceased 5-7 d before; (4) Ceased 8-14 d before	Incidence of PBB 8.2%
Albéniz et al[114]	2020	Spain	Prospective	1034	Size: ≥ 20 mm (mean size 30.5 mm)	EMR	Thienopyridines (ceased 5 d before)	Study expressed risk of PPB on antiplatelet monotherapy as OR: 2.51, 95%CI: 0.99-6.34, P < 0.001 (either aspirin or thienopyridine monotherapy)

OR: Odds ratio; EMR: Endoscopic mucosal resection; PPB: Post-procedural bleeding.

Table 30 Endoscopic submucosal dissection

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Igarashi et al[56]	2017	Japan	Retrospective	90	Gastric ESD	Thienopyridines either: (1) Continued until day of; (2) Ceased 3-7 d before	Incidence of PPB 5.6% (continued). Incidence of PPB 12.5% (ceased)
Ono et al[128]	2017	Japan	Prospective	10	Gastric ESD	Thienopyridines (continued)	Incidence of PPB 20%
Sato et al[57]	2017	Japan	Retrospective	19	Gastric ESD	Thienopyridines(ceased 5-7 d before)	No incidence of PPB
Oh et al[116]	2018	South Korea	Retrospective	56	Gastric ESD	Thienopyridines either: (1) Ceased 0-4 d before; (2) Ceased 5-7 d before	Incidence of PPB 3.6%
Nam et al[118]	2019	South Korea	Retrospective	31	Gastric ESD	Thienopyridines(ceased 7 d before)	Incidence of PPB 19.4%

ESD: Endoscopic submucosal dissection; PPB: Post-procedural bleeding.

Table 31 Endoscopic retrograde cholangiopancreatography with sphincterotomy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Patai et al[66]	2014	Hungary	Prospective	29	Sphincterotomy	Thienopyridine (continued)	Incidence of delayed PPB 3.5%. Incidence of immediate/intraprocedural bleeding 3.5%
Ikarashi et al[68]	2017	Japan	Retrospective	1113	Sphincterotomy	Thienopyridine (ceased 5-7 d before)	Incidence of delayed PPB 3.0%. (study categorised cessation of thienopyridine, warfarin and DOAC into the same “discontinuation” group)
Yamamiya et al[122]	2019	Japan	Retrospective	76	Sphincterotomy	Thienopyridine (either continued or ceased 5-7 d or switched to aspirin monotherapy before)	No incidence of PPB in either continuous or cessation group

PPB: Post-procedural bleeding; DOAC: Direct oral anticoagulant.

Table 32 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Richter et al[124]	2011	United States	Retrospective	990	PEG	Thienopyridines(continued)	No incidence of PPB ≤ 48 h post-PEG. Incidence of PPB > 48 h post-PEG 4%
Singh et al[98]	2012	United States	Retrospective	143	PEG	Thienopyridines (ceased on average 2.2 d before)	Incidence of PPB 2.1%
Lozoya-González et al[99]	2012	Mexico	Retrospective	24	PEG	Thienopyridines (ceased 1-3 d before)	No incidence of PPB
Lee et al[123]	2013	South Korea	Retrospective	81	PEG	Thienopyridines (continued)	No incidence of PPB

PPB: Post-procedural bleeding; PEG: Percutaneous endoscopic gastrostomy.

Table 33 Diagnostic endoscopy and colonoscopy with biopsy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Ono et al[104]	2012	Japan	Prospective	101	Endoscopic biopsy	DAPT (continued)	No Incidence of PPB
Ara et al[6]	2015	Japan	Prospective	3758	Endoscopic biopsy	DAPT either: (1) Continued; (2) Ceased before	Incidence of PPB on DAPT (continued) 0.35%. No incidence of PPB with DAPT (cessation)
Yuki et al[7]	2017	Japan	Prospective	277	Endoscopic biopsy	DAPT (continued)	No incidence of PPB
Kono et al[105]	2017	Japan	Prospective	221	Endoscopic biopsy	DAPT (continued)	No incidence of PPB

DAPT: Dual antiplatelet therapy; PPB: Post-procedural bleeding.

Table 34 Endoscopic ultrasound ± fine needle aspiration

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Kawakubo et al[106]	2018	Japan	Prospective	85	EUS + FNA (for solid lesions only). Pancreatic cysts excluded	DAPT (ceased thienopyridine 5 d before and bridged with aspirin monotherapy)	Incidence of PPB 3.6%

EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; DAPT: Dual antiplatelet therapy; PPB: Post-procedural bleeding.

Table 35 Polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Singh et al[28]	2010	United States	Retrospective	77	Size: < 5 mm to ≥ 10 mm	Polypectomy	DAPT (continued)	Incidence of delayed PPB 5.2%
Feagins et al[30]	2011	United States	Retrospective	118	Size: < 20 mm and > 20 mm	Polypectomy	DAPT (continued)	Incidence of PPB 0.85%
Kishida et al[41]	2019	Japan	Retrospective	6382	Size: < 10 mm or ≥ 10 mm	Polypectomy	DAPT either: (1) Ceased 7 d before (before 2012); (2) Bridged with aspirin monotherapy (after 2012)	Incidence of PPB 1.8%
Watanabe et al[109]	2020	Japan	Retrospective	50	Size: < 10 mm or ≥ 10 mm	Polypectomy	DAPT (various timing of agent continuation or switching strategies)	Incidence of PPB 6%

DAPT: Dual antiplatelet therapy; PPB: Post-procedural bleeding.

Table 36 Cold snare polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Arimoto et al[111]	2019	Japan	Retrospective	516	Size: ≤ 10 mm	CSP	DAPT (continued)	No incidence of PPB
Won et al[112]	2019	South Korea	Prospective	91	Size: ≤ 10 mm	CSP	DAPT (continued)	Incidence of PPB 2.4%

CSP: Cold snare polypectomy; DAPT: Dual antiplatelet therapy; PPB: Post-procedural bleeding.

Table 37 Endoscopic mucosal resection

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Ono et al[113]	2019	Japan	Retrospectively	825	Size: Median size ranged from 8.5-9.5 ± 5 mm	EMR	DAPT (thienopyridines ceased and aspirin monotherapy continued)	Incidence of PPB per polyp resection 1.35% (aspirin/thienopyridine/DAPT)
So et al[50]	2019	South Korea	Retrospective	399	Size: Mean lesion size 34 mm	EMR and ESD	DAPT (varying patterns of agent continuation or switching strategies)	Incidence of PPB 12.3%

EMR: Endoscopic mucosal resection; DAPT: Dual antiplatelet therapy; PPB: Post-procedural bleeding; ESD: Endoscopic submucosal dissection.

Table 38 Endoscopic submucosal dissection

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Sato et al[57]	2017	Japan	Retrospective	75 (2378)	ESD	DAPT (ceased thienopyridine before and bridged with aspirin monotherapy)	Incidence of PPB 30.7%
Kono et al[58]	2018	Japan	Retrospective	6 (872)	ESD	DAPT (ceased thienopyridine 7 d before and bridged with aspirin monotherapy)	Incidence of PPB 67.7%
Oh et al[116]	2018	South Korea	Retrospective	51 (215)	ESD	DAPT either: (1) Ceased 5-7 d before (discontinuation group); (2) Ceased 0-4 d before (continuation group)	Incidence of delayed PPB 27.5% (14/51)
Harada et al[117]	2019	Japan	Retrospective	59 (597)	ESD	DAPT either: (1) Ceased thienopyridine 5 d before and bridged with aspirin monotherapy (high-risk conditions); (2) DAPT ceased > 5 d before (low-risk conditions)	Incidence of PPB 23.1% (aspirin monotherapy bridging). Incidence of PPB 5.0% (DAPT ceased)

ESD: Endoscopic submucosal dissection; DAPT: Dual antiplatelet therapy; PPB: Post-procedural bleeding.

Table 39 Endoscopic retrograde cholangiopancreatography with sphincterotomy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Mok et al[130]	2017	United States	Prospective	50	Sphincterotomy	DAPT (continued)	Incidence of PPB 3.6%
Yamamiya et al[122]	2019	Japan	Retrospective	76	Sphincterotomy	DAPT either: (1) Continued; (2) Ceased 5-7 d. And switched to aspirin monotherapy before	No incidence of PPB in either continuous or cessation group

DAPT: Dual antiplatelet therapy; PPB: Post-procedural bleeding.

Table 40 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Lee et al[123]	2013	South Korea	Retrospective	40 (1625)	PEG	DAPT (ceased 4 d before)	Incidence of PPB on DAPT 2.5%
Singh et al[98]	2012	United States	Retrospective	122 (1541)	PEG	DAPT	Incidence of PPB 2.5%
Lozoya-González et al[99]	2012	Mexico	Retrospective	91	PEG	DAPT (ceased 1-3 d before)	Incidence of PPB 0%

PEG: Percutaneous endoscopic gastrostomy; DAPT: Dual antiplatelet therapy; PPB: Post-procedural bleeding.

Table 41 Diagnostic endoscopy and colonoscopy with biopsy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Fujita et al[5]	2015	Japan	Retrospective	47	Endoscopic biopsy	Warfarin (continued)	No incidence of PPB. Risk of immediate/intraprocedural bleeding 4.3%
Ara et al[6]	2015	Japan	Prospective	3758	Endoscopic biopsy	Warfarin either: (1) Continued; (2) Ceased before	No incidence of PPB on continuous or Warfarin cessation
Ono et al[104]	2012	Japan	Prospective	101	Endoscopic biopsy	Warfarin (continued)	No Incidence of PPB
Yuki et al[7]	2017	Japan	Prospective	277	Endoscopic biopsy	Warfarin (continued)	No incidence of PPB
Kono et al[105]	2017	Japan	Prospective	221	Endoscopic biopsy	Warfarin (continued)	No incidence of PPB when on warfarin monotherapy

PPB: Post-procedural bleeding.

Table 42 Endoscopic ultrasound ± fine needle aspiration

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Inoue et al[17]	2017	Japan	Retrospective	742	EUS + FNA	Warfarin (ceased 4 d before)	No incidence of bleeding in either discontinuation warfarin or HBT
Kawakubo et al[106]	2018	Japan	Prospective	85	EUS + FNA	Warfarin (ceased 3 d with HBT before)	Incidence of PPB with HBT 4%

EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; PPB: Post-procedural bleeding; HBT: Heparin bridging therapy.

Table 43 Polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Horiuchi et al[133]	2014	Japan	Prospective	35	Size: ≤ 10 mm	Polypectomy	Warfarin (continued)	Incidence of PPB 14%
Beppu et al[134]	2014	Japan	Retrospective	20	Size: ≥ 20 mm and < 20 mm	Polypectomy	Warfarin ± HBT (ceased at least 5 d before)	Incidence of PPB 52.2%
Yanagisawa et al[1]	2018	Japan	Retrospective	486	Size: < 10 mm or ≥ 10 mm	Polypectomy	Warfarin ± HBT (ceased 3-5 d before)	Incidence of PPB 13.7%. Incidence of PPB on HBT 21.7%
Lin et al[107]	2018	United States	Retrospective	427	Size: < 20 or ≥ 20 mm	Polypectomy	Warfarin ± HBT (ceased 3-5 d before)	Incidence of PPB 0.66%
Yu et al[127]	2019	United States	Retrospective	3471	N/S	Polypectomy	Warfarin ± HBT (ceased before procedure)	Incidence of PPB 1.2%
Kishida et al[41]	2019	Japan	Retrospective	6382	Size: < 10 mm or ≥ 10 mm	Polypectomy	Warfarin ± HBT (ceased 3-4 d before)	Incidence of PPB 2.3%. Incidence of PPB with HBT 20% (study did not discern rates between warfarin vs DOAC)
Amato et al[108]	2019	Italy	Prospective	n=1504	Size: ≥ 10 mm	Polypectomy	Warfarin(ceased median 5 d before)	Incidence of PPB 8.5% (anticoagulant monotherapy)(study did not discern rates between warfarin vs DOAC)

PPB: Post-procedural bleeding; HBT: Heparin bridging therapy; DOAC: Direct oral anticoagulant; N/S: Not stated.

Table 44 Cold snare polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Horiuchi et al[133]	2014	Japan	Prospective	35	Size: ≤ 10 mm	CSP	Warfarin (continued)	No incidences of PPB
Makino et al[110]	2018	Japan	Prospective	69	Size: ≤ 10 mm	CSP	Warfarin (continued)	No incidences of PPB. Incidence of immediate/intraprocedural bleeding 5.7%
Arimoto et al[111]	2019	Japan	Retrospective	501	Size: ≤ 10 mm	CSP	Warfarin (continued)	No incidences of PPB. Incidence of immediate/intraprocedural bleeding 9.8%

CSP: Cold snare polypectomy; PPB: Post-procedural bleeding.

Table 45 Endoscopic mucosal resection

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Fujita et al[135]	2018	Japan	Prospective (non-HBT group). Retrospective (HBT group)	43/41	Size: < 10 mm (mean size 7.2-7.8 mm ± 2.2-3.2 mm)	EMR	Warfarin ± HBT (ceased morning of)	No incidence of PPB (non-HBT group). Incidence of PPB 9.8% (HBT group)
Ono et al[113]	2019	Japan	Retrospective	24	Size: Median size ranged from 8.5-9.5 ± 5 mm between groups	EMR	Warfarin ± HBT either: Continued; ceased 3 d before procedure	Incidence of PPB (without HBT) 10%. Incidence of PPB (with HBT) 21.4%
So et al[50]	2019	South Korea	Retrospective	1197	Size: Mean lesion size 34 mm	EMR	Warfarin either: Ceased day of; 0-4 d before; ceased 5-7 d before; ceased 8-14 d before	Incidence of PPB 16.7% (specific PPB rates between warfarin and DOACs N/S). Incidence of PPB (HBT group) 35.7%
Albéniz et al[114]	2020	Spain	Prospective	76	Size: ≥ 20 mm (mean size 30.5 mm)	EMR	Warfarin (ceased 5 d before with HBT)	Increased risk of PPB with anticoagulant use (OR: 4.54, 95%CI: 2.14-9.63, P < 0.001). Incidence of PPB not specified in study

EMR: Endoscopic mucosal resection; HBT: Heparin bridging therapy; PPB: Post-procedural bleeding; N/S: Not stated; OR: Odds ratio.

Table 46 Endoscopic submucosal dissection

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Igarashi et al[56]	2017	Japan	Retrospective	67	ESD	Warfarin ± HBT either: (1) Received till day of; (2) Ceased 3-7 d before; (3) HBT 3-7 d before	Incidence of PPB 10.0% (warfarin and DOAC combined). Incidence of PPB 10.8% (HBT group)
Sato et al[57]	2017	Japan	Retrospective	93	ESD	Warfarin ± HBT (ceased 3-5 d before)	Incidence of PPB 5.9% (without HBT). Incidence of PPB (with HBT) 30.7%
Furuhata et al[115]	2017	Japan	Retrospective	253	ESD	Warfarin ± HBT (ceased 3-4 d before)	Incidence of PPB 7.3% (Warfarin and DOAC combined). Incidence of PPB 28.8% (with HBT)
Yoshio et al[132]	2017	Japan	Retrospective	97	ESD	Warfarin ± HBT (ceased 4-5 d before)	No incidence of PPB (without HBT). Incidence of PPB (with HBT) 31.6%
Harada et al[136]	2017	Japan	Prospective	45	ESD	Warfarin ± HBT either: (1) Continued; (2) Switched to HBT	Incidence of PPB 9.1% (warfarin continued). Incidence of PPB 21.7% (HBT)
Kono et al[58]	2018	Japan	Retrospective	872	ESD	Warfarin ± HBT (ceased 1-3 d before with or without HBT)	Incidence of PPB 6.4% (without HBT). Incidence of PPB 29% (with HBT) (warfarin and DOACs combined)
Yamashita et al[60]	2018	Japan	Retrospective	650	ESD	Warfarin with HBT	Incidence of PPB 26.3% (with HBT)
Nam et al[118]	2019	South Korea	Retrospective	1942	ESD	Warfarin ± HBT (ceased 7 d before)	Incidence of PPB 3.2%
Harada et al[61]	2020	Japan	Retrospective	26	ESD	Warfarin ± HBT either: (1) Continued; (2) Ceased 4-5 d ± HBT before	Incidence of PPB 7.7%

ESD: Endoscopic submucosal dissection; HBT: Heparin bridging therapy; PPB: Post-procedural bleeding; DOAC: Direct oral anticoagulant.

Table 47 Endoscopic retrograde cholangiopancreatography with sphincterotomy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Paik et al[137]	2018	South Korea	Retrospective	96	Sphincterotomy	Warfarin with HBT	Incidence of delayed PPB 7.3%
Muro et al[138]	2020	Japan	Retrospective	149	Sphincterotomy	Warfarin either: (1) Continued; (2) With HBT	Incidence of PPB 8.3% (warfarin continued). Incidence of PPB 4.0% (with HBT)
Yamamiya et al[122]	2019	Japan	Retrospective	76	Sphincterotomy	Warfarin: (1) Continued; (2) With HBT	No incidence of PPB in either continuous or HBT group
Ikarashi et al[68]	2017	Japan	Retrospective	1113	Sphincterotomy	Warfarin either: (1) Ceased 4-5 d before; (2) With HBT	Incidence of delayed PPB 3.0% (study categorised cessation of thienopyridine, warfarin and DOAC into the same “discontinuation” group). Incidence of PPB 8.0% (with HBT)

HBT: Heparin bridging therapy; PPB: Post-procedural bleeding.

Table 48 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Lee et al[123]	2013	South Korea	Retrospective	71	PEG	Warfarin (continuation or cessation details N/S)	Study findings expressed as an OR. Increased risk of PPB with anticoagulant use (OR: 7.26, 95%CI: 2.23-23.68, P = 0.001)
Singh et al[98]	2012	United States	Retrospective	326	PEG	Warfarin ± HBT	Without HBT group: (1) Incidence of PPB 5.4% (without HBT); (2) Increased risk of PPB without HBT (OR: 1.08, 95%CI: 0.47-2.49, P = 0.860). HBT group: (1) Incidence of PPB with HBT 7.9% (11/140); (2) Increased risk of PPB with HBT (OR: 2.66, 95%CI: 1.18-5.99, P = 0.018)
Lozoya-González et al[99]	2012	Mexico	Retrospective	91	PEG	Warfarin either: (1) Ceased > 48h with HBT before; (2) Ceased 1-5 d before	No incidence of PPB

N/S: Not stated; OR: Odds ratio; PEG: Percutaneous endoscopic gastrostomy; HBT: Heparin bridging therapy; PPB: Post-procedural bleeding.

Table 49 Diagnostic endoscopy and colonoscopy with biopsy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Fujita et al[5]	2015	Japan	Retrospective	5 (7939)	Endoscopic biopsy	DOAC (continued)	No incidence of PPB
Ara et al[6]	2015	Japan	Prospective	394 (3758)	Endoscopic biopsy	DOAC either: (1) Continued; (2) Ceased before	No incidence of PPB(in both continuous and DOAC cessation group)
Yuki et al[7]	2017	Japan	Prospective	45 (549)	Endoscopic biopsy	DOAC (continued)	No incidence of PPB
Kono et al[105]	2017	Japan	Prospective	51 (221)	Endoscopic biopsy	DOAC (continued)	No incidence of PPB

PPB: Post-procedural bleeding; DOAC: Direct oral anticoagulant.

Table 50 Endoscopic ultrasound ± fine needle aspiration

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Kawakubo et al[106]	2018	Japan	Prospective	85	EUS + FNA	DOAC (ceased 48 h with HBT before)	No incidence of PPB with HBT

EUS: Endoscopic ultrasound; FNA: Fine needle aspiration; HBT: Heparin bridging therapy; PPB: Post-procedural bleeding.

Table 51 Polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Beppu et al[134]	2014	Japan	Retrospective	1 (52)	Size: ≥ 20 mm and < 20 mm	Polypectomy	DOAC (ceased at least 5 d before)	Expressed as OR. Increased risk of PPB with DOAC use (OR: 10.2, 95%CI: 2.7-38.3, P = 0.0006)
Yanagisaw et al[1]	2018	Japan	Retrospective	73 (436)	Size: < 10 mm or ≥ 10 mm	Polypectomy	DOAC (ceased 24-48 h before ± HBT)	Incidence of PPB 13.8%
Yu et al[127]	2019	United States	Retrospective	1590 (611487)	N/S	Polypectomy	DOAC (ceased before)	Incidence of PPB 0.6%
Kishida et al[41]	2019	Japan	Retrospective	87 (6382)	Size: < 10 mm or ≥ 10 mm	Polypectomy	DOAC (ceased 24-48 h before)	Incidence of PPB 2.3% (study did not discern rates between warfarin vs DOAC)
Amato et al[108]	2019	Italy	Prospective	1504	Size: ≥ 10 mm	Polypectomy	DOAC (ceased median 5 d before)	Incidence of PPB 8.5% (study did not discern anticoagulant rates between warfarin vs DOACs)

DOAC: Direct oral anticoagulant; OR: Odds ratio; PPB: Post-procedural bleeding.

Table 52 Cold snare polypectomy

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Makino et al[110]	2018	Japan	Prospective	17 (172)	Size: ≤ 10 mm	CSP	DOAC (continued)	Incidence of PPB 1.2%
Arimoto et al[111]	2019	Japan	Retrospective	65 (501)	Size: ≤ 10 mm	CSP	DOAC (continued)	No incidence of PPB

CSP: Cold snare polypectomy; DOAC: Direct oral anticoagulant; PPB: Post-procedural bleeding.

Table 53 Endoscopic mucosal resection

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Fujita et al[135]	2018	Japan	Prospective (non-HBT group) and retrospective (HBT group)	84	Size < 10mm (mean size 7.2-7.8 ± 2.2-3.2 mm	EMR	DOAC ± HBT (ceased morning of)	Incidence of PBB 2.3% (non-HBT). No incidence of PPB (HBT)
Ono et al[113]	2019	Japan	Retrospective	825	Size median size 8.5-9.5 ± 5 mm between groups	EMR	DOACs (ceased day of)	Incidence of PPB 6.5%
So et al[50]	2019	South Korea	Retrospective	399 (1197)	Size mean lesion 34 mm	EMR and ESD	DOAC (ceased day of procedure or 0-4 d before or ceased 5-7 d before or ceased 8-14 d before procedure)	Incidence of PPB 16.7% (anticoagulant group) (study did not specify the risk comparing warfarin and DOAC individually)
Albénizet al[114]	2020	Spain	Prospective	977	Size ≥ 20mm (mean size 30.5 mm)	EMR	DOAC (ceased 48-72 h before)	Expressed as OR (OR: 4.54, 95%CI: 2.14-9.63, P < 0.001) (anticoagulant use) (specific PPB rates between warfarin and DOACs not specified)

EMR: Endoscopic mucosal resection; DOAC: Direct oral anticoagulant; ESD: Endoscopic submucosal dissection; HBT: Heparin bridging therapy; OR: Odds ratio; PPB: Post-procedural bleeding.

Table 54 Endoscopic submucosal dissection

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Igarashi et al[56]	2017	Japan	Retrospective	30	ESD	DOAC (ceased 3-7 d before)	Incidence of PPB 10.0% (warfarin and DOAC combined)
Sato et al[57]	2017	Japan	Retrospective	18	ESD	DOAC (ceased 24-48 h before)	Incidence of PPB 5.6%
Yoshio et al[132]	2017	Japan	Retrospective	24	ESD	DOAC: (1) Rivaroxaban/Apixaban ceased 2 d before; (2) Dabigatran ceased 1-2 d before	Incidence of PPB on Rivaroxaban 45.5%. No incidence of PPB on dabigatran or apixaban
Kono et al[58]	2018	Japan	Retrospective	872	ESD	DOAC either: (1) Ceased 1-3 d before; (2) Ceased 2 d before with HBT	DOACs ceased 1-3 d before without HBT group: (1) Incidence of PPB 6.4%; (2) Warfarin and DOACs with HBT: Incidence of PPB 29%
Yamashita et al[60]	2018	Japan	Retrospective	650	ESD	DOAC (ceased morning of)	Incidence of PPB 22.2%
Harada et al[61]	2020	Japan	Retrospective	25	ESD	DOAC (ceased 1 d before ± HBT)	Incidence of PPB 16%

DOAC: Direct oral anticoagulant; ESD: Endoscopic submucosal dissection; HBT: Heparin bridging therapy; OR: Odds ratio; PPB: Post-procedural bleeding.

Table 55 Endoscopic retrograde cholangiopancreatography with sphincterotomy

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Yamamiya et al[122]	2019	Japan	Retrospective	76	Sphincterotomy	DOAC either: (1) Continued; (2) Switched to HBT before	No incidence of PPB in either continuous or HBT group
Muro et al[138]	2020	Japan	Retrospective	62 (149)	Sphincterotomy	DOAC: (1) Continued; (2) With HBT	No incidence of PPB (continued DOAC). Incidence of PPB 6.5% (HBT)

DOAC: Direct oral anticoagulant; HBT: Heparin bridging therapy; PPB: Post-procedural bleeding.

Table 56 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion

Ref.	Year	Country	Study design	n	Procedure	Medication	Relative risk
Lee et al[123]	2013	South Korea	Retrospective	71 (1625)	PEG	DOAC (N/S whether continued or ceased before)	Study expressed risk of PPB as OR (OR: 7.26, 95%CI: 2.23-23.68, P = 0.001) (included both warfarin and DOAC)

DOAC: Direct oral anticoagulant; OR: Odds ratio; PPB: Post-procedural bleeding; PEG: Percutaneous endoscopic gastrostomy.