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2015 ; 21
(46
): 13166-76
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Endoscopy in neutropenic and/or thrombocytopenic patients
#MMPMID26674926
Tong MC
; Tadros M
; Vaziri H
World J Gastroenterol
2015[Dec]; 21
(46
): 13166-76
PMID26674926
show ga
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 PubMed, 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/mm(3) in four
studies and less than 10000/mm(3) in one study. Other thrombocytopenic
precautions included withholding of biopsy if platelet count was less than
30000/mm(3) in one study and less than 20000/mm(3) 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/mm(3) 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.
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