Endoscopic Procedures in Severe Neutropenia

Abstract

Introduction: Gastroenterologists are often consulted for diagnostic endoscopy in neutropenic patients. However, there is limited data on the safety and diagnostic yield of endoscopy in patients with severe neutropenia (absolute neutrophil count ≤500 cells/μL). Often these procedures are performed to manage gastrointestinal bleeding or to identify opportunistic infection, mucositis, and GVHD. While complications are rare in the general population, many gastroenterologists have concerns about the safety of endoscopy in neutropenic patients. Methods: This retrospective review identified 22 patients with severe neutropenia who underwent endoscopy between 2010 and 2014. Data collected included gender, age, primary cause of neutropenia, antibiotic use, indication for endoscopy, endoscopic and pathologic diagnosis, complications surrounding the procedure, and mortality. Results: Among the 22 severely neutropenic patients who underwent endoscopy, the mean age was 56 years (SD 14) and 68% were male. The indications for endoscopy included gastrointestinal bleeding (36%), odynophagia or dysphagia (27%), diarrhea (9%), and variceal screening(9%). Upper endoscopy was performed in 77% of cases. Causes of neutropenia included leukemia, lymphoma, cirrhosis, and sepsis. The ANC was < 100 cells/μL in three patients. Nine patients underwent endoscopy with biopsies or brushings (45%). Three patients became febrile within 48 hours of the endoscopy but none of these episodes were associated with bacteremia. There were no episodes of perforation, bleeding, aspiration pneumonia, or transfer to an intensive care unit associated with the endoscopy. Sixty-five percent of patients were on broad-spectrum antibiotics on the day of the procedure. Endoscopy frequently made or confirmed a diagnosis with a diagnostic yield of 83%. Conclusion: In our series of severely neutropenic patients, endoscopy did not cause significant complications. Most of the endoscopies were performed to diagnose gastrointestinal bleeding and dysphagia and the diagnostic yield of endoscopy was high. Periprocedural risk may have been mitigated by a high rate of broad spectrum antibiotic use and a lack of higher risk procedures such as esophageal dilation, variceal sclerotherapy, and ERCP. This case series demonstrates that carefully performed endoscopy is a safe procedure with low morbidity even in severely neutropenic patients. Neutropenia should not be a barrier to obtaining important diagnostic information via endoscopic procedures.Table 1: Demographic Data and Results