Safety of argon plasma coagulation for small bowel angiodysplasia during balloon-assisted enteroscopy in patients on antithrombotic therapy: a single-centre observational cohort study.

OBJECTIVES

Patients with small bowel angiodysplasia are frequently prescribed antithrombotic therapy. Although balloon-assisted enteroscopy (BAE) is classified as a low-risk procedure, guidelines acknowledge limited data to guide periprocedural antithrombotic management for argon plasma coagulation (APC) of small bowel angiodysplasia, resulting in variation in practice. We aimed to evaluate the safety of continuing antithrombotic therapy for APC performed at BAE.

METHODS

We conducted a retrospective observational cohort study of consecutive BAEs performed February 2022 to June 2025 at a tertiary referral centre. Patients with capsule-confirmed small bowel angiodysplasia, again identified at BAE, were included. At our centre, antithrombotic therapy is not routinely interrupted for BAE. Demographics, antithrombotic exposure, lesion characteristics, procedural details, and complications were recorded. Outcomes were compared between procedures performed on and off therapy.

RESULTS

Ninety-five BAE procedures were performed in 84 patients (median age 72 years, IQR 65.5-79; 60% male), with antithrombotic therapy continued in 54 procedures (57%), including antiplatelet (38%), anticoagulant (14%), and combined therapy (5%). Lesion burden was high, with multiple angiodysplasias in 85% and large lesions (≥5 mm) in 61%. Median insertion depth was 270 cm (IQR 200-320). Lesion burden and procedural characteristics were similar between procedures performed on and off therapy. Most procedures were under conscious sedation (97%), adjunctive clips were used infrequently (8%), and APC was delivered almost universally at 25 W. No intraprocedural or delayed complications occurred.

CONCLUSION

APC for small bowel angiodysplasia during BAE was performed safely without interrupting antithrombotic therapy, including in older patients with high lesion burden.