Safety Of Endoscopic Procedures Research Articles

Safety of Endoscopic Procedures in Thrombocytopenia and Neutropenia: Embracing Assurance.

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. We explore the pooled rates of safety and adverse effects of endoscopic interventions in thrombocytopenia and neutropenia patients via a systematic review & meta-analysis. 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. I2% heterogeneity was used to assess the heterogeneity. Six studies and four studies evaluated endoscopic outcomes in patients with thrombocytopenia and neutropenia respectively with mean age was 56years. The pooled rate of total post-biopsy bleeding and total post-polypectomy bleeding among patients with thrombocytopenia was 4% (95% CI 1-11), I2 = 84%, and 12% (95% CI 3-36) I2 = 43%. The total rate of post procedure-related bleeding in thrombocytopenia was 5% (95% CI 1-14) I2 = 95%. The pooled rate of post-endoscopic infection (fever from any cause, bacteremia) in neutropenia was 10% (95% CI 3-28%) I2 = 96%. On sub analysis, the pooled rate of bacteremia and 30days all-cause mortality in neutropenia was 4% (95% CI 3-5%) I2 = 0% and 13% (95% CI 4-34%) I2 = 95% respectively. 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.

The Safety of Endoscopic Procedures in Patients With Thrombocytopenia: A Systematic Review and Meta-Analysis.

Endoscopic procedures are essential in gastroenterology but pose significant risks for thrombocytopenic patients who have lower platelet counts, increasing the likelihood of bleeding complications. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to assess bleeding risks in thrombocytopenic patients undergoing various endoscopic procedures. A comprehensive search was conducted across databases like PubMed, MEDLINE, and EBSCO, using stringent criteria for inclusion and exclusion, with study quality assessed via the Newcastle-Ottawa Scale and thrombocytopenia severity classified by Common Terminology Criteria for Adverse Events (CTCAE) criteria. Statistical analysis focused on bleeding event incidence rates at different platelet count thresholds, utilizing RevMan Web (Cochrane, London, UK) and Excel (Microsoft® Corp., Redmond, WA). The search yielded 1,675 potential articles, but only three retrospective cohort studies were selected. Results showed a significant increase in bleeding risk for patients with platelet counts below 50,000/mm3, particularly under 25,000/mm3, with a 5.5% prevalence of post-procedure bleeding in moderate to severe thrombocytopenic patients versus 4.0% in those with higher counts, and a threefold higher risk in severe thrombocytopenia. The study highlights the need for meticulous pre-procedure assessments in thrombocytopenic patients and points out disparities in guideline recommendations, suggesting personalized approaches based on patient-specific risks. It underscores balancing diagnostic yield against bleeding risks, especially in severe thrombocytopenia, and discusses the controversial role of prophylactic platelet transfusions, advocating for a nuanced approach. In conclusion, this meta-analysis provides critical insights into managing thrombocytopenia in endoscopic procedures, emphasizing the importance of individualized patient assessment and adherence to evolving guidelines, and underlining the necessity of further research to refine these guidelines and improve patient safety and outcomes in this challenging clinical scenario.

Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines

Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.

Safety of endoscopic procedures with monopolar versus bipolar instruments in an ex vivo porcine model

BackgroundMonopolar instruments are generally used in colorectal endoscopic mucosal resection (EMR). Bipolar instruments have previously been reported to be as safe as monopolar instruments. We sought to compare the safety of the monopolar and bipolar snare and hemostatic forceps in an animal model.MethodsWe created 5-mm, 10-mm, and 15-mm target lesions on an ex vivo porcine rectum. Two lesions of each size were resected via monopolar polypectomy (M-P), monopolar EMR (M-E), bipolar polypectomy (B-P), and bipolar EMR (B-E). We performed a pathological evaluation of the conditions of perforation and the effects of burning on the tissues. In addition, we burned the muscularis propria covered with submucosal layer using monopolar and bipolar hemostatic forceps and performed pathological evaluations.ResultsPolypectomy and EMR were performed in a total of 24 target lesions. A perforation was found on histology in one case of M-P and one case of M-E after removing target lesions of 15 mm in diameter. There were no perforations during endoscopic resection using the bipolar snare. The thermal denaturation in B-P did not reach the muscularis propria layer regardless of the size of the target lesion. Although thermal damage after using monopolar hemostatic forceps was extensive, thermal denaturation was only seen on the surface of the submucosal layer when bipolar hemostatic forceps were used.ConclusionsBipolar instruments cause less damage to the tissue than monopolar instruments. Our results also suggest that bipolar instruments may be safer than monopolar instruments in endoscopic procedures for colorectal lesions.

Feasibility and Safety of Endoscopic Procedure in Burr-Hole Surgery for Chronic Subdural Hematoma in Patients of Very Advanced Age

The usefulness of endoscopic procedures for chronic subdural hematoma (CSDH) has been described, but the indications in patients of very advanced age have not been analyzed. The aim of this study was to evaluate the feasibility, safety, and usefulness of introduction of an endoscopic procedure for such patients. We retrospectively analyzed the data of 540 CSDHs treated by burr-hole surgery with endoscopic examination. The safety of the endoscopic procedure was assessed according to postoperative complications, morbidity, and mortality. The outcome was evaluated by statistical comparison among 4 different age-groups, and the recurrence rate and risk factors for recurrence was investigated in patients of very advanced age. Postoperative complications occurred in 7 cases (1.5%). The 6-month morbidity and mortality were 13.5% and 4.5%. No complications, morbidity, or mortality associated with the additional endoscopic procedure occurred even in patients of very advanced age. The endoscopic features of trabecular structures and residual septa separating the cavity were also risk factors for recurrence in patients of very advanced age. Releasing of the septa showed the possibility of decreasing the risk of recurrence to 6.6% in patients aged ≥85 years as well as in younger patients. There were some inevitable problems such as prolongation of the surgical time and inadequate endoscopic surgical skill. An endoscopic procedure for CSDH can be safely indicated and useful even in patients aged ≥85 years. However, clinicians should carefully select the patients based on clinical information associated with risk factors for recurrence.

The safety of upper gastrointestinal endoscopic biopsy in patients receiving antithrombic drugs. A single-centre prospective observational study.

IntroductionIn July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines on gastroenterological endoscopy in patients undergoing antithrombotic therapy, although the safety of endoscopic procedures in patients receiving antithrombotic drugs has yet to be sufficiently studied.AimThis study evaluates the safety of upper gastroenterological endoscopic biopsy in patients receiving antithrombotic drugs. We evaluated the prospective observational safety of endoscopic biopsy performed in the endoscopy unit of our patients using antithrombotic drugs.Material and methodsOesophagogastroduodenoscopies (OGD) and biopsies performed at a single endoscopy unit between July 2018 and February 2019 were examined in this prospective observational study. Patients receiving antithrombotic drugs due to cardiovascular and neurological reasons, who underwent an endoscopic mucosal biopsy for diagnostic purposes, were included in the study.ResultsThe study was completed with 166 patients who underwent an endoscopic biopsy, from whom a total of 327 biopsies taken. The patients were examined in two groups: those “receiving antithrombotic drugs” and those who had “stopped taking antithrombotic drugs”. There was no statistically significant difference between the two groups with respect to bleeding.ConclusionsThis prospective observational study showed that performing an endoscopic biopsy without the cessation of antithrombotic drugs does not increase bleeding risk. Low-risk procedures, such as endoscopic mucosal biopsies, can be performed confidently by experienced endoscopists.

Sa1530 Safety of Endoscopy Following Acute Coronary Syndrome: a Systematic Review

The safety of endoscopy shortly after an acute coronary syndrome (ACS) has been poorly characterized. Following ACS, patients are at increased risk of cardiopulmonary sequelae, which may be compounded by the physiologic stress of endoscopy and its potential complications. The aim of this study is to perform a systematic review on the safety of endoscopic procedures following ACS.

Endoscopy in the Elderly

With increasing age, the incidence of both benign and malignant gastrointestinal (GI) disease rises. Endoscopic procedures are commonly performed in elderly and very elderly patients to diagnose and treat GI disorders. There are a number of issues to contemplate when considering performing an endoscopic procedure in an elderly patient, including the anticipated benefits of endoscopy as well as the increased risks associated with procedural sedation and some endoscopic procedures. This review will focus on the yield and safety of endoscopic procedures in older adults.

The Impact of Pre-Procedure Blood Pressure on Cardiopulmonary Events During Colonoscopy

Purpose: The safety of endoscopic procedures is remarkable, especially when considering the co-morbidities patients often have prior to these exams. One understudied issue is the impact of pre-procedural blood pressure (BP) levels on outcomes. Current guidelines are based on expert opinion and suggest that a pre-procedure systolic BP (SBP) > 180 and/or diastolic BP (DBP) > 120 are unsafe. Our purpose was to determine the impact of pre-procedure BP levels and anti-hypertensive medications on procedural outcomes. Methods: Prospective, cross-sectional survey of outpatients undergoing colonoscopy for any indication. We restricted enrollment to procedures using conscious sedation. We recorded median BP prior to, during, and after the procedure,as well as sedative dosages. Additional procedural data included heart rate, oxygen saturation, and respiratory rate. Complications during recovery were identified. Results: We enrolled 643 patients - 346 (53.8%) females and mean age 55.6 ± 10.6 y. The majority of patients were black (58.9%). ASA grades were I (14 %), II (83.2 %), III (2.8%), and IV (0 %). Mean dose of fentanyl was 106.3 ± 32.1 μg and midazolam 5.6 ± 2.0 mg. There were 140 (21.8%) patients taking an antihypertensive medication. Median pre-procedure SBP and DBP were 134.0 and 79.0 mmHg. One 57y male patient developed bradycardia that responded to atropine. His pre-, intra-, and post-procedure BPs ranged from 100-140 over 70-90 mmHg. Otherwise, we found no correlation between pre-procedure SBP and intra-procedure or post-procedure O2 saturation, respiratory rate, or heart rate after controlling for age, gender, ASA class, sedative doses, and procedure duration. However, DBP correlated weakly with procedural (r=0.14; p=0.001) and post-procedural (r=0.09; p=0.02) heart rate. There were 10 patients who underwent colonoscopy despite a SBP > 180 mmHg (none were treated for pre-procedure HTN). There was no difference (all p > 0.05) in mean procedural and post-procedural HR, RR, and O2 saturation compared to those with better BP control. Median drop in SBP for these patients was 3 and 19 mmHg during and after the procedure. Median drop in DBP was 7 and 3 mmHg. No procedural cardiac or pulmonary events occurred in this group. Conclusion: In a large sample of outpatients undergoing colonoscopy, we found little evidence that pre-procedure BP elevation correlated with pulmonary or cardiac adverse events. For asymptomatic outpatients with an elevated SBP or DBP, we suggest proceeding with the endoscopic exam. SBP will drop ˜ 20 mmHg by the end of the procedure without treatment. For severe elevations (e.g. SBP > 200 mmHg), we suggest a low dose of hydralazine or labetolol to attain acceptable BP levels rather than cancellation.

Tu1395 Safety of Endoscopic Procedures in Patients With Severe Thrombocytopenia

Tu1395 Safety of Endoscopic Procedures in Patients With Severe Thrombocytopenia

Utility and Safety of Endoscopic Procedures in Neutropenic Patients with Gastrointestinal Bleeding

Background: The utility and safety of esophagogastroduodenoscopy (EGD) and colonoscopy in neutropenic patients with gastrointestinal bleeding is unknown. Aims: To evaluate the diagnostic yield and safety of endoscopic procedures in patients with neutropenia, as defined by an absolute neutrophil count (ANC) < 500 cells/μL. Methods: Retrospective review of 1938 inpatients with gastrointestinal bleeding who had endoscopic evaluation at M.D. Anderson Cancer Center over a 10-year period. Patients with an ANC < 500 cells/μL were identified.