Endoscopy in neutropenic and/or thrombocytopenic patients

• Published in: World journal of gastroenterology : WJG 2015-12, Vol.21 (46), p.13166-13176
• Main Authors: Tong, Michelle C, Tadros, Micheal, Vaziri, Haleh
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Bacterial Infections - microbiology; Bacterial Infections - prevention & control; Endoscopy, Gastrointestinal - adverse effects; Endoscopy; Neutropenia; Cancer; Bone; Hemorrhage - etiology; Hemorrhage - prevention & control; Humans; marrow; Neutropenia - blood; Neutropenia - complications; Neutropenia - diagnosis; Platelet Transfusion; Practice Guidelines as Topic; Predictive Value of Tests; Risk Assessment; Risk Factors; Systematic Reviews; Thrombocytopenia - blood; Thrombocytopenia - complications; Thrombocytopenia - diagnosis; transplan
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i46.13166

AIM: To evaluate the safety of endoscopic procedures in neutropenic and/or thrombocytopenic cancer patients. METHODS: We performed a literature search for English language studies in which patients with neutropenia and/or thrombocytopenia underwent endoscopy. Studies were included if endoscopic procedures were used as part of the evaluation of neutropenic and/or thrombocytopenic patients,yielding 13 studies. Two studies in which endoscopy was not a primary evaluation tool were excluded. Eleven relevant studies were identified by two independent reviewers on Pub Med,Scopus,and Ovid databases.RESULTS: Most of the studies had high diagnostic yield with relatively low complication rates. Therapeutic endoscopic interventions were performed in more than half the studies,including high-risk procedures,such as sclerotherapy. Platelet transfusion was given if counts were less than 50000/mm3 in four studies and less than 10000/mm3 in one study. Other thrombocytopenic precautions included withholding of biopsy if platelet count was less than 30000/mm3 in one study and less than 20000/mm3 in another study. Two of the ten studies which examined thrombocytopenic patient populations reported bleeding complications related to endoscopy,none of which caused major morbidity or mortality. All febrile neutropenic patients received prophylactic broad-spectrum antibiotics in the studies reviewed. Regarding afebrile neutropenic patients,prophylactic antibiotics were given if absolute neutrophil count was less than 1000/mm3 in one study,if the patient was undergoing colonoscopy and had a high inflammatory condition without clear definition of significance in another study,and if the patient was in an aplastic phase in a third study. Endoscopy was also withheld in one study for severe pancytopenia. CONCLUSION: Endoscopy can be safely performed in patients with thrombocytopenia/neutropenia. Prophylactic platelet transfusion and/or antibiotic administration prior to endoscopy may be considered in some cases and should be individualized.