Endoscopy in neutropenic and/or thrombocytopenic patients

Table 2 Study design and characteristics of patients and endoscopies

Study	Design	Patient and endoscopic characteristics
Buderus et al[19] (2012)	Retrospective 1995-2004	38 pediatric cancer patients with various GI complaints
		40 diagnostic endoscopies, 7 follow-up endoscopies, 10 therapeutic endoscopies
		Diagnostic yield 82.5%: Gastritis, esophagitis, duodenitis, colitis, Mallory-Weiss tears, ulcer
Chu et al[17] (1983)	Retrospective 1978-1979	133 cancer patients with thrombocytopenia and overt GI bleed
		187 diagnostic endoscopies, no therapeutic endoscopies
		Diagnostic yield 92% for upper, 60% for lower exam: Unifocal and multifocal lesions in majority; rare diffuse bleeding
Gorschlüter et al[20] (2008)	Retrospective 1993-2005	104 acute leukemia patients after myelosuppressive chemotherapy
		131 primary endoscopies, 40 follow-up endoscopies; includes 16 therapeutic interventions and 5 ERCPs (2 for jaundice, 2 for suspicion of cholecystitis, 1 for suspicion of cholangitis)
		Diagnostic yield 91% for upper, 70% for lower exam: esophagitis, gastric erosions, hiatal hernia, gastritis
Kaur et al[22] (1996)	Retrospective 1986-1993	43 post-bone marrow transplant patients with overt GI bleed
		31 endoscopies total: 26 EGD, 5 colonoscopy; 2 endoscopies required hemostasis
		Diagnostic yield 100% for upper, 80% for lower exam: Diffuse esophagitis, gastritis, or duodenitis in upper exam; 2 ulcers, 1 colitis, 1 tumor recurrence in lower exam
Kaur et al[23] (2013)	Retrospective 2007-2010	11 pediatric patient requiring PEG placement in anticipation of BMT (BMT group) compared with 30 patients requiring PEG placement for other indications (comparison group)
Khan et al[24] (2006)	Retrospective 1995-2002	191 pediatric patients who underwent hematopoietic stem cell transplantation
		198 EGDs, 220 lower endoscopies. All diagnostic endoscopies for GI complaints, mostly for nausea, vomiting, and non-bloody diarrhea.
		Diagnostic yield 32% for upper, 16% for lower exam:
		Mucosal abnormalities most common
		Acute GVHD in 14% on histological exam
		Non-GVHD histological evidence of inflammation in 24%
Park et al[21] (2010)	Retrospective 2002-2007	32 patients with aplastic anemia and overt GI bleed, each evaluated by endoscopy, 3 of which required therapeutic intervention
		Diagnostic yield 66%: bleeding sites in esophagus, stomach, duodenum, small intestine, large intestine
Ross et al[25] (2008)	Retrospective 2002-2006	112 patients with simultaneous upper and lower endoscopic procedures following hematopoietic stem cell transplant. All diagnostic endoscopies for GI symptoms
		Diagnostic yield: GVHD diagnosed in 81% of patients
Schulenburg et al[26] (2004)	Prospective cohort 1996-2001	42 post-allogeneic stem cell transplant patients admitted for GI complaints
		22 upper, 12 lower, and 13 upper and lower endoscopies performed, unclear distinction between primary and follow-up endoscopies
		Diagnostic yield 100%: Majority GVHD, gastritis, CMV, bacterial enteritis
Schwartz et al[18] (2001)	Prospective cohort 1985-1987 and 1996-1997	1102 patients with hematopoietic cell transplantation followed prospectively, of whom 75 developed severe GI bleed. Endoscopic evaluation included diagnostic and therapeutic procedures, however, number of procedures was unclear
		Diagnostic yield: Majority had multiple sites of bleed, caused by GVHD and peptic acid esophageal ulcers
Soylu et al[27] (2005)	Prospective cohort 1999-2005	451 patients with hematological malignancies, of which 32 developed overt GIB
		25 upper GI bleeding episodes, of which 8 EGDs were performed, remainder managed by supportive care. The other 7 patients had lower GI bleed episodes caused by neutropenic enterocolitis excluding the need for endoscopic procedures.
		Diagnostic yield 100% (8 endoscopies): Erosive gastritis (5/8), duodenal ulcers (3/8) in upper GI bleed

GI: Gastrointestinal; ERCP: Endoscopic retrograde cholangiopancreatography; EGD: Esophagogastroduodenoscopy; PEG: Percutaneous endoscopic gastrostomy; GVHD: Graft-vs-host disease.