I read with interest the recent guideline by Veitch et al. (Gut 2008;57:1322–9). These authors present an interesting review on risk stratification of endoscopic procedures based on American Society of Gastrointestinal Endoscopy guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedure.1 They make the important point that warfarin and clopidogrel may be continued for low-risk procedures.

Recently, we published a paper on managing anticoagulation and antiplatelet medications in gastrointestinal (GI) endoscopy through an international survey.2 In our survey, it appeared that Eastern endoscopists do not typically perform endoscopic biopsy while their patients are on warfarin therapy and do not perform a polypectomy while their patients are taking aspirin. This occurred despite several published (Western) guidelines that suggest it is safe to perform endoscopic biopsy during warfarin therapy or a polypectomy while on aspirin medication. We speculate that Eastern endoscopists believe it to be dangerous to follow Western guidelines because of an increased risk of bleeding in Asian patients. To explain this discrepancy, differences in effectiveness and side effects of antiplatelets and anticoagulants between the …