Background: In the setting of endoscopy in an anticoagulated patient, the endoscopist must assess the risk of complications related to intercurrent bleeding or thrombosis and plan the endoscopic procedure accordingly. A recent survey across the Northern region of England revealed a huge variation in practice. This is not surprising in the absence of a national guideline. Recently the American Society for Gastrointestinal Endoscopy (ASGE) has published guidelines on this subject.

Aim: To survey the current practice of endoscopy in anticoagulated patients among endoscopists across Wales using the ASGE guidelines as a benchmark.

Methods: A postal questionnaire was sent to all endoscopists identified from each endoscopy department across Wales irrespective of qualification and experience. The questionnaire was constructed based on the ASGE guidelines as follows. (1)Procedure risk- bleeding related to an endoscopic intervention carried out in the setting of anticoagulation, and (2) Condition risk- a thromboembolism event related to interruption of anticoagulation for a particular condition. High-risk procedures were- polypectomy, dilatation, endoscopic sphincterotomy, PEG, laser ablation/coagulation and all the rest were low risk procedures.High-risk conditions were- mechanical prosthetic valve, atrial fibrillation with underlying heart disease, recurrent thromboembolism and the rest were low risk conditions.

Results: A total of 90 questionnaires were sent and we received, 58 (52%) replies. There were 33 consultants, 7 middle-grade doctors, 4 general practitioners, 13 trainees and 1 nurse endoscopist. Twenty-seven (47%) respondents considered endoscopic biopsy as a high-risk procedure. Twenty-nine (50%) considered bioprosthetic valve as a high-risk condition. Twenty-four (41%) did not consider atrial fibrillation with underlying heart disease and recurrent thromboembolism as a high risk condition and 8 (14%) considered atrial fibrillation without underlying heart disease as a high risk condition. Six (10%) would not use intravenous heparin after stopping warfarin in high-risk conditions. All except 2 (3%) considered …