Safety of Endoscopic Procedures in Thrombocytopenia and Neutropenia: Embracing Assurance

Abstract

Background: 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.

Aim: We explore the pooled rates of safety and adverse effects of endoscopic interventions in thrombocytopenia and neutropenia patients via a systematic review & meta-analysis.

Methods: 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.

Results: Six studies and four studies evaluated endoscopic outcomes in patients with thrombocytopenia and neutropenia respectively with mean age was 56 years. 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 30 days all-cause mortality in neutropenia was 4% (95% CI 3-5%) I² = 0% and 13% (95% CI 4-34%) I² = 95% respectively.

Conclusion: 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.

Keywords: Bleeding; Endoscopic procedures; Infection; Neutropenia; Thrombocytopenia.