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"Colorectal cancer (CRC) is one of the top three leading causes of death in both men and women. However, screening can help detect and prevent CRC. Multiple guidelines recommend CRC screening using stool-based screening and direct visualization via colonoscopy. Anatomically, women have a longer total colonic length, especially in the transverse colon, which makes it redundant; thus it is more difficult to perform complete endoscopy in women. Women also have a higher risk of developing right-sided colon cancer of the flat and depressed type, which is harder to detect than the other types. Moreover, women are less likely to undergo colonoscopy due to embarrassment, especially when the procedure is performed by male gastroenterologists, and the lack of available female gastroenterologists further complicates the problem. The current COVID-19 pandemic also decreases patients’ willingness to undergo screening due to the fear of contracting the COVID-19. Delay in diagnosis leads to more advanced tumors upon detection and ultimately decreases the survival rate, especially in women, as they have lower 1-year survival rate when CRC is detected in its later stages than in men. Innovative options for CRC screening have recently emerged, including colon capsule endoscopy, which can be performed in a clinic and may reduce the need for colonoscopy. However, sex-specific CRC screening guidelines and tools are not available. The objective of this review is to identify the barriers and challenges faced when performing screening colonoscopy in women, especially during the pandemic and to encourage the development of sex-specific CRC screening."

"Dual antiplatelet therapy (DAPT) is the mainstay of secondary prevention treatment for acute coronary syndrome (ACS) and ischemic stroke, especially after coronary intervention. DAPT consists of aspirin and P2Y12 receptor inhibitor (e.g. clopidogrel), and the use of DAPT has been increased over time. The most serious and common adverse effect is gastrointestinal bleeding. Guidelines in managing such condition are available among Gastroenterologist Societies and Cardiologist Societies. Most guidelines are consistent with each other to continue the use of aspirin while withholding P2Y12. However, European Society of Cardiologist (ESC) guideline in 2017 recommends P2Y12 receptor inhibitor as the preferred antiplatelet for patient with upper gastrointestinal bleeding. This review will look on the guidelines and other supporting evidence for the justification on the antiplatelet of choice.

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Dual antiplatelet therapy (DAPT) adalah tatalaksana utama dalam pencegahan sekunder untuk Sindrom koroner akut, stroke iskemik, terutama setelah intervensi koroner. DAPT terdiri dari dua obat yaitu Aspirin dan golongan P2Y12 reseptor inhibitor (contohnya clopidogrel), yang penggunaannya meningkat seiring waktu. Efek samping yang paling serius yang paling sering dijumpai adalah pendarahan pada saluran cerna. Panduan klinis dalam menangani keadaan tersebut dapat dijumpai pada Panduan Perhimpunan Gastroenterologi dan Perhimpunan Kardiolog. Hampir semua setuju untuk melanjutkan aspirin dan menghentikan P2Y12 reseptor inhibitor. Namun demikian, European Society of Cardiologist (ESC) pada panduannya di tahun 2017 merekomendasikan inhibitor P2Y12 sebagai anti platelet pilihan pada pasien dengan pendarahan saluran cerna atas. Artikel ini akan membandingkan panduan klinis dan bukti-bukti penelitian yang mendasari pilihan anti platelet.

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"Endoscopic procedure is commonly used to make diagnosis or therapy. Endoscopy has risk on the procedure or after the procedure. Patient with antithrombotic therapy, both antiplatelet and/or anticoagulant, for underlying diseases has higher risk for bleeding and thromboembolic events in this procedure. The physician should consider risk and benefit for adjusting the antithrombotic therapy, in addition to minimize bleeding and thromboembolic events. For low risk procedure, adjustments in antithrombotic therapy usually not necessarily needed. For high risk procedure, there are several adjustments based on the type of medication and patient’s condition in specific. European Society of Gastrointestinal Guidelines Endoscopy (ESGE) and British Society of Gastrointestinal (BSG); American Society of Gastrointestinal Endoscopy (ASGE); and lastly Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) have published guidelines to help physician to make decisions regarding antithrombotic therapy management during endoscopy. This article compares and contrasts the approach of each guideline, in design to help the decision-making process. However, each patient’s clinical condition may differ from one to another and should be considered carefully in making a final decision

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Prosedur endoskopi seringkali digunakan untuk mendiagnosis ataupun terapi. Endoskopi memiliki risiko baik saat prosedur maupun setelah prosedur. Pasien dengan terapi antitrombotik, baik antiplatelet dan/atau antikoagulan, sebagai terapi penyakit yang mendasari memiliki risiko tinggi untuk perdarahan dan tromboemboli pada prosedur ini. Dokter perlu mempertimbangkan risiko dan keuntungan untuk melakukan penyesuaian pada terapi antitrombotik, dengan tujuan untuk menurunkan risiko perdarahan dan tromboemboli. Untuk prosedur risiko rendah, pada umumnya tidak memerlukan penyesuaian terapi. Untuk prosedur risiko tinggi, ada beberapa penyesuaian berdasarkan tipe medikasi dan kondisi pasien secara spesifik. European Society of Gastrointestinal Guidelines Endoscopy (ESGE) dan British Society of Gastrointestinal (BSG); American Society of Gastrointestinal Endoscopy (ASGE); dan terakhir Asian Pacific Association of Gastroenterology (APAGE) dan Asian Pacific Society for Digestive Endoscopy (APSDE) telah mengeluarkan panduan untuk membantu dokter dalam mengambil keputusan pada kasus pasien endoskopi dengan terapi antitrombotik. Artikel ini bertujuan untuk membandingkan setiap pedoman untuk memudahkan proses pengambilan keputusan. Walapun demikian, kondisi pasien dapat berbeda satu sama lain, sehingga pengambilan keputusan akhir perlu dipertimbangkan secara cermat pada setiap kondisi pasien"