Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2015; 21(46): 13166-13176
Published online Dec 14, 2015. doi: 10.3748/wjg.v21.i46.13166
Endoscopy in neutropenic and/or thrombocytopenic patients
Michelle C Tong, Micheal Tadros, Haleh Vaziri
Michelle C Tong, Micheal Tadros, Haleh Vaziri, Division of Gastroenterology, University of Connecticut School of Medicine, Farmington, CT 06030-8074, United States
Author contributions: Tong MC, Tadros M, and Vaziri H drafted the manuscript; and Tong MC and Vaziri H revised the manuscript.
Conflict-of-interest statement: No conflicts of interest exist for any of the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Haleh Vaziri, Assistant Professor, Division of Gastroenterology, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030-8074, United States. hvaziri@uchc.edu
Telephone: +1-860-6796524 Fax: +1-860-6793159
Received: June 15, 2015
Peer-review started: June 19, 2015
First decision: July 10, 2015
Revised: August 8, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: December 14, 2015
Processing time: 176 Days and 19.2 Hours
Abstract

AIM: To evaluate the safety of endoscopic procedures in neutropenic and/or thrombocytopenic cancer patients.

METHODS: We performed a literature search for English language studies in which patients with neutropenia and/or thrombocytopenia underwent endoscopy. Studies were included if endoscopic procedures were used as part of the evaluation of neutropenic and/or thrombocytopenic patients, yielding 13 studies. Two studies in which endoscopy was not a primary evaluation tool were excluded. Eleven relevant studies were identified by two independent reviewers on PubMed, Scopus, and Ovid databases.

RESULTS: Most of the studies had high diagnostic yield with relatively low complication rates. Therapeutic endoscopic interventions were performed in more than half the studies, including high-risk procedures, such as sclerotherapy. Platelet transfusion was given if counts were less than 50000/mm3 in four studies and less than 10000/mm3 in one study. Other thrombocytopenic precautions included withholding of biopsy if platelet count was less than 30000/mm3 in one study and less than 20000/mm3 in another study. Two of the ten studies which examined thrombocytopenic patient populations reported bleeding complications related to endoscopy, none of which caused major morbidity or mortality. All febrile neutropenic patients received prophylactic broad-spectrum antibiotics in the studies reviewed. Regarding afebrile neutropenic patients, prophylactic antibiotics were given if absolute neutrophil count was less than 1000/mm3 in one study, if the patient was undergoing colonoscopy and had a high inflammatory condition without clear definition of significance in another study, and if the patient was in an aplastic phase in a third study. Endoscopy was also withheld in one study for severe pancytopenia.

CONCLUSION: Endoscopy can be safely performed in patients with thrombocytopenia/neutropenia. Prophylactic platelet transfusion and/or antibiotic administration prior to endoscopy may be considered in some cases and should be individualized.

Keywords: Endoscopy; Neutropenia; Cancer; Bone marrow transplant; Bleeding; Hemorrhage; Infection; Fever; Complication; Thrombocytopenia

Core tip: Gastroenterologists are often requested to perform endoscopic evaluation in neutropenic and thrombocytopenic patients. Endoscopists may be hesitant to perform these procedures in these situations, due to the fear of possible complications, such as bleeding and infection. In this systematic review, we provide gastroenterologists with the available safety data, preventive measures prior to the procedures, and the diagnostic yield of the procedures in this patient population.