Safety of Endoscopic Procedures in Thrombocytopenia and Neutropenia: Embracing Assurance

• Published in: Digestive diseases and sciences Vol. 69; no. 7; pp. 2354 - 2362
• Main Authors: Loganathan, Priyadarshini, Mohan, Babu P., Alderman, David, Gajendran, Mahesh, Moond, Vishali, Adler, Douglas G.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2024; Springer Nature B.V
• Subjects: Biochemistry; Endoscopy; Endoscopy, Gastrointestinal - adverse effects; Endoscopy, Gastrointestinal - methods; Gastroenterology; Hepatology; Humans; Medicine; Medicine & Public Health; Middle Aged; Neutropenia; Neutropenia - epidemiology; Oncology; Original Article; Thrombocytopenia; Thrombocytopenia - epidemiology; Transplant Surgery; Thrombocytopenia; Infection; Endoscopic procedures; Bleeding; Neutropenia
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-024-08467-w

Background
Few studies have evaluated the post-endoscopic adverse events in patients with neutropenia and thrombocytopenia. Current guidelines do not provide clear direction on this topic.
Aim
We explore the pooled rates of safety and adverse effects of endoscopic interventions in thrombocytopenia and neutropenia patients via a systematic review & meta-analysis.
Methods
Databases, including Medline, Scopus, and Embase, were searched (in May 2023) using specific terms for studies evaluating the clinical outcomes of endoscopy in patients with thrombocytopenia and neutropenia. Standard meta-analysis methods were employed using the random-effects model.
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% heterogeneity was used to assess the heterogeneity.
Results
Six studies and four studies evaluated endoscopic outcomes in patients with thrombocytopenia and neutropenia respectively with mean age was 56 years. The pooled rate of total post-biopsy bleeding and total post-polypectomy bleeding among patients with thrombocytopenia was 4% (95% CI 1–11),
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 = 84%, and 12% (95% CI 3–36)
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 = 43%. The total rate of post procedure-related bleeding in thrombocytopenia was 5% (95% CI 1–14)
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 = 95%. The pooled rate of post-endoscopic infection (fever from any cause, bacteremia) in neutropenia was 10% (95% CI 3–28%)
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 = 96%. On sub analysis, the pooled rate of bacteremia and 30 days all-cause mortality in neutropenia was 4% (95% CI 3–5%)
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 = 0% and 13% (95% CI 4–34%)
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 = 95% respectively.
Conclusion
Our data supports the notion that endoscopic procedures are safe for neutropenic, thrombocytopenic patients with suitable indications and reasonable functional status and have an acceptable risk/benefit ratio.