Tu1069 THE SAFETY OF ENDOSCOPY AMONG PATIENTS ON ANTIANGIOGENIC AGENTS: A SINGLE CENTER EXPERIENCE

Abstract

Antiangiogenic agents (AAs) are now increasingly used for the treatment of metastatic malignant tumors but are associated with a higher risk of gastrointestinal (GI) bleeding and perforation. Given their adverse effects profile, it is recommended that elective surgery should be delayed for 28 days from completion of AAs treatment. As gastroenterologist, understanding endoscopic-related adverse effects are crucial for optimal patient care. To date, there is limited data regarding the safety among patients undergoing endoscopic procedures while on AAs. To determine the procedure-related adverse effects and mortality rate among patients that undergo endoscopic procedures while on AAs. This is a retrospective single center study of adult (> 18 years old) patients who underwent endoscopic procedures within 28 days of administration of antiangiogenic agents which includes vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor (VEGFR) inhibitors, epidermal growth factor receptor (EGFR) inhibitors, multi-targeted tyrosine kinase inhibitors, and mammalian target of rapamycin (mTOR) inhibitors. The primary outcomes were procedure-related adverse events and mortality within 30 days of endoscopy. Endoscopic procedures were also categorized into high-risk and low-risk based on risk of perforation and GI bleeding. 29 patients (male/female= 16/13) with a mean age of 67 years underwent a total of 39 endoscopic procedures within 31 days of treatment with AAs. 58.6% (17/29) had metastatic disease and most common primary sites include liver (27.6%), colorectal (13.8%), gastric (10.3%) and renal (10.3%). Of the 39 endoscopic procedures performed, 10 (25.6%) were considered high-risk which include variceal banding, percutaneous gastrostomy tube placement, and colonic stent placement, whereas 29 (74.4%) were low-risk. The average time duration from administration of AAs to endoscopy was 5.6 days. There were no procedure-related adverse effects, but 1 patient on Lenvatinib for metastatic hepatocellular carcinoma had persistent bleeding despite endoscopic banding of esophageal varices and died 4 days after the procedure from hemorrhagic shock. In this single center retrospective study, the results suggest that endoscopic procedures performed while on antiangiogenic agents has low procedure-related adverse events and mortality. The risk likely is attributed to the advanced disease of these patients. However, future prospective studies are needed to confirm this finding.View Large Image Figure ViewerDownload Hi-res image Download (PPT)