Introduction: Non-intraaortic balloon pump percutaneous mechanical circulatory assist devise are used in advanced heart failure with severely reduced ejection fraction. A subtype of this category, left ventricular assist devise (LVAD) was initially used as a bridge therapy to transplantation, however, as technology and survival rates improved, now used as destination therapy. One of the complications of LVAD implantation is bleeding, resulting from need for anticoagulation therapy and development of acquired von-Willebrand disease. The most common source of gastrointestinal (GIB) is arteriovenous malformations (AVMs). To this date, data is limited on safety of endoscopic procedures post-implantation. In our study we evaluated the periprocedural management and safety of endoscopic therapy in patients on anticoagulation. Methods: We conducted a 5 year retrospective analysis from a single tertiary care center in LVAD patients who underwent endoscopy. Procedural indications were pre-implantation screening or post-implantation suspected GIB. All patients were on anticoagulation or antiplatelet therapy prior to endoscopy. During all procedures LVAD trained personnel was present. Periprocedural monitoring and fluid management was guided by Doppler assisted non-invasive blood pressure (NIBP) and LVAD pulsatility index. In patients with overt GIB, anticoagulation was held but not completely reversed (INR<2). In patients who presented for elective procedure(s), anticoagulation was bridged to heparin (INR<2) and heparin was held 4 hours prior to procedure. Anticoagulation was resumed immediately after completion of procedure(s). Results: A total of 51 LVADs were implanted. 86 procedures were performed in 28 patients. 81 procedures were performed under deep sedation and 5 required general anesthesia. 92.3% of procedures were performed at bedside in ICU while 5.16% were performed in the operative room. No adverse events were noted in post-procedural period. 8 patients underwent snare polypectomy or EMR during colonoscopy. 3 out of 8 patients developed post-polypectomy bleeding which was endoscopically managed without stopping anticoagulation. Conclusion: Gastroscopy, colonoscopy and push enteroscopy are safe procedures in LVAD patients and can safely be performed on anticoagulation as long as INR is<2, even in cases of overt GIB. Monitoring of LVAD patients during procedure can be done with NIBP and pulse oximetry when an LVAD trained personnel is available to monitor LVAD pulsatility index.