Endoscopy.

Abstract

Introduction: To develop clinical recommendation regarding endoscopic procedures in neutropenic and/or thrombocytopenic patients. Methods: Review article of 11 relevant studies in which endoscopy was performed as part of the evaluation of neutropenic and/or thrombocytopenic patients. The studies were identified by 2 independent reviewers on PubMed, Scopus, and Ovid databases. Results: There was a high diagnostic yield with relatively low complication rates reported, related to the endoscopic procedures in patients with neutropenia and/or thrombocytopenia. Therapeutic endoscopic interventions including high-risk procedures such as sclerotherapy were safely performed in this group of patients, as were feeding tube placement and hemostasis via electrocautery, epinephrine injection, argon plasma coagulation, and fibrin glue. Indication for prophylactic platelet transfusions for thrombocytopenia patients ranged from platelet counts <50,000 per cubic mm to counts <10,000 per cubic mm. Several studies withheld biopsy for platelet counts <20,000-30,000 per cubic mm. Bleeding complications related to endoscopy were reported in 2 of 10 studies, but none resulted in major morbidity or mortality. Afebrile neutropenic patients received prophylactic antibiotics if absolute neutrophilic count (ANC) was <1000 per cubic mm, if the patient was undergoing colonoscopy and had a high inflammatory condition, or if the patient was in an aplastic phase. Endoscopy was also withheld in one study for severe pancytopenia. Conclusion: Endoscopy can be safely performed in the settings of thrombocytopenia and neutropenia. Prophylactic platelet transfusion prior to endoscopy may be considered for platelet count <50,000 per cubic mm, although platelet count below 50,000 per cubic mm is not an absolute contraindication to endoscopy. In afebrile patients with neutropenia, prophylactic antibiotics may be given for high-risk endoscopic procedures. For low-risk procedures in afebrile neutropenic patients, endoscopists may consider prophylactic antibiotics based on the clinical setting.Table 1: Recommended Guidelines