Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

Abu-Sbeih, Hamzah; Ali, Faisal S.; Coronel, Emmanuel; Chen, Hsiang Chun; Wang, Xuemei; Lum, Phillip; Shuttlesworth, Gladis; Bhutani, Manoop S.; Raju, Gottumukkala S.; Lee, Jeffrey H.; Stroehlein, John R.; Ross, William A.; Wang, Yinghong

doi:10.1016/j.gie.2018.12.004

Cited by 19 publications

(17 citation statements)

References 31 publications

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“…Further, none of the endoscopies that required hemostasis for intra-endoscopic bleeding had subsequent uncontrolled bleeding. Similarly low complication rates have been reported in the literature, including two studies of adult cancer patients with thrombocytopenia and neutropenia which found post-endoscopic complication rates of less than 5%[ 28 , 29 ]. Additionally, we found no significant differences in adverse events when comparing the thrombocytopenic and non-thrombocytopenic groups and the neutropenic and non-neutropenic groups.…”

Section: Discussionsupporting

confidence: 56%

“…These findings suggest that endoscopic evaluation for aGVHD in this vulnerable population may be safe regardless of pre-procedure platelet and neutrophil count, challenging the need for thresholds set in place by endoscopy societies. Taken together with the findings of recent papers[ 28 , 29 ], a prospective, controlled study evaluating platelet and neutrophil thresholds for endoscopy should be conducted to potentially limit transfusions and aid in antibiotic and neutrophil-stimulation pharmacological stewardship efforts.…”

Section: Discussionmentioning

confidence: 99%

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Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

Rajan

Trieu

Lin

et al. 2020

WJGE

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BACKGROUND Acute gastrointestinal (GI) graft- vs -host disease (aGVHD) is the most complication of hematopoietic stem cell transplant (HSCT) in patients with hematologic malignancy. Limited data exists on endoscopic evaluation of GVHD in post-HSCT patients with differing GI symptoms. Further, the diagnostic value of gross endoscopic findings as well as the safety of endoscopy in this commonly thrombocytopenic and neutropenic patient population remains unclear. AIM To understand the diagnostic value of symptoms and gross endoscopic findings as well as safety of endoscopy in aGVHD patients. METHODS We analyzed 195 endoscopies performed at City of Hope in patients who underwent allogeneic HSCT less than 100 d prior for hematologic malignancy and were subsequently evaluated for aGVHD via endoscopy. The yield, sensitivity, and specificity of diagnosing aGVHD were calculated for upper and lower endoscopy, various GI tract locations, and presenting symptoms. RESULTS Combined esophagogastroduodenoscopy (EGD) and flexible sigmoidoscopy (FS) demonstrated a greater diagnostic yield for aGVHD (83.1%) compared to EGD (66.7%) or FS (77.2%) alone with any presenting symptom. The upper and lower GI tract demonstrated similar yields regardless of whether patients presented with diarrhea (95.7% vs 99.1%) or nausea/vomiting (97.5% vs 96.8%). Normal-appearing mucosa was generally as specific (91.3%) as abnormal mucosa (58.7%-97.8%) for the presence of aGVHD. Adverse events such as bleeding (1.0%), infection (1.0%), and perforation (0.5%) only occurred in a small proportion of patients, with no significant differences in those with underlying thrombocytopenia ( P = 1.000) and neutropenia ( P = 0.425). CONCLUSION Combined EGD and FS with biopsies of normal and inflamed mucosa demonstrated the greatest diagnostic yield regardless of presenting symptom and appears to be safe in this population of patients.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

Rajan

Trieu

Lin

et al. 2020

WJGE

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“…La información sobre el riesgo de complicaciones infecciosas asociadas a procedimientos endoscópicos en pacientes inmunocomprometidos y la eficacia del uso de antibióticos profilácticos para su prevención es extremadamente limitada. Los estudios publicados tienen limitaciones de diseño y tamaño de muestra; incluyen pacientes con gran heterogeneidad en cuanto a riesgos, edad y tipo de procedimiento realizado, así como uso de diferentes definiciones de infección; además de no incluir grupos control, por lo que se desconoce si el riesgo de complicaciones infecciosas asociado a procedimientos endoscópicos es mayor en personas inmunocomprometidas comparadas con poblaciones sin inmunocompromiso 8,[61][62][63][64] .…”

Section: Uso De Antibióticos Profilácticos Durante Procedimientos Endoscópicos En Pacientes Inmunocomprometidos Con Neutropenia Grave Y/ounclassified

“…En un estudio retrospectivo realizado en un centro de referencia oncológico en la ciudad de Houston entre 2010 y 2015 61 se estudiaron pacientes afebriles con neutropenia (< 1,000 neutrófilos/µl totales) en el día previo a los procedimientos que incluyeron endoscopias de bajo y alto riesgo de infección de acuerdo con la clasificación propuesta por la ASGE 8 (Tabla 3).…”

Section: Uso De Antibióticos Profilácticos Durante Procedimientos Endoscópicos En Pacientes Inmunocomprometidos Con Neutropenia Grave Y/ounclassified

“…En el 73% de los procedimientos se realizó alguna intervención endoscópica (toma de biopsias en el 48%). En total, el 9% de los procedimientos se clasificaron de alto riesgo de infección 61 . Solo 24 pacientes (4%), en 28 procedimientos endoscópicos, desarrollaron alguna complicación infecciosa en la semana siguiente al procedimiento (definida como la presencia de fiebre o infección).…”

Section: Uso De Antibióticos Profilácticos Durante Procedimientos Endoscópicos En Pacientes Inmunocomprometidos Con Neutropenia Grave Y/ounclassified

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Guía de prevención de infecciones y uso de antibióticos profilácticos en endoscopia

Blanco-Vela¹,

Peláez-Luna

Martínez-García³

et al. 2021

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La endoscopia tiene el riesgo inherente de introducir bacterias en el organismo a través de las membranas mucosas, lo que podría ocasionar bacteriemia y posterior infección. El valor del uso de antibióticos profilácticos en pacientes que requieren procedimientos endoscópicos ha sido objeto de debate y su uso debe considerar el riesgo individual de cada paciente para desarrollar infecciones. La Asociación Mexicana de Endoscopia Gastrointestinal convocó a un grupo de endoscopistas, gastroenterólogos y enfermeros especializados en procesamiento de endoscopios con la finalidad de evaluar de manera crítica la evidencia científica y proponer estrategias para el uso racional de antibióticos mediante un consenso.

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Infectious events after endoscopic procedures in patients with neutropenia and hematologic diseases

et al. 2022

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Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

Cited by 19 publications

References 31 publications

Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

Assessing the yield and safety of endoscopy in acute graft-vs-host disease after hematopoietic stem cell transplant

Guía de prevención de infecciones y uso de antibióticos profilácticos en endoscopia

Infectious events after endoscopic procedures in patients with neutropenia and hematologic diseases

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