Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2022; 14(7): 416-423
Published online Jul 16, 2022. doi: 10.4253/wjge.v14.i7.416
Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review
Mohammad Azam, Amit Hudgi, Pearl Princess Uy, Jinal Makhija, John Erikson L Yap
Mohammad Azam, Amit Hudgi, Department of Internal Medicine, Medical College of Georgia/Augusta University, Augusta, GA 30912, United States
Pearl Princess Uy, John Erikson L Yap, Division of Gastroenterology, Medical College of Georgia/Augusta University, Augusta, GA 30912, United States
Jinal Makhija, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, United States
Author contributions: Azam MU and Hudgi AR performed the research, collected the data, wrote the paper, contributed to analysis and reviewed the article; Uy P collected the data and reviewed the article; Makhija J performed the formal analysis; Yap JE conceptualized, supervised the report and approved the final draft submitted.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Augusta University Medical Centre.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at Consent was not obtained as this was a retrospective study. No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Noncommercial (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:
Corresponding author: John Erikson L Yap, MD, Assistant Professor, Division of Gastroenterology, Medical College of Georgia/Augusta University, 1120 15th Street, Augusta, GA 30912, United States.
Received: February 28, 2022
Peer-review started: February 28, 2022
First decision: April 13, 2022
Revised: May 8, 2022
Accepted: June 15, 2022
Article in press: June 15, 2022
Published online: July 16, 2022

Antiangiogenic agents (AAs) are increasingly used to treat malignant tumors and have been associated with gastrointestinal (GI) bleeding and perforation. Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment. Data regarding the safety of endoscopy while on antiangiogenic agents is extremely limited. No guidelines are in place to address the concern about withholding these anti-angiogenic drugs.


To evaluate the risks of endoscopy in patients on antiangiogenic agents from 2015 to 2020 at our institution.


This is a single centered retrospective study approved by the institutional review board statement of the institution. Patients that underwent endoscopy within 28 d of antiangiogenic agents’ treatment were included in the study. Primary outcome of interest was death, and secondary outcomes included perforation and GI bleeding. Data were analyzed utilizing descriptive statistics. Fifty-nine patients were included in the final analysis and a total of eighty-five procedures were performed that were characterized as low risk and high risk.


Among the 59 patients a total of 85 endoscopic procedures were performed with 24 (28.2%) categorized as high-risk and 61 (71.8%) procedures as low-risk. Of the total number of patients, (50%) were on bevacizumab and the rest were on imatinib (11.7%), lenvatinib (6.7%) and, ramucirumab (5%). The average duration between administration of AAs and the performance of endoscopic procedures was 9.9 d. No procedure-related adverse events were noted among our study population. We did observe two deaths with one patient, on lenvatinib for metastatic hepatocellular carcinoma, who had persistent bleeding despite esophageal variceal banding and died 4 d later from hemorrhagic shock. Another patient was diagnosed with acute myeloid leukemia died 24 d after an esophagogastroduodenoscopy with biopsy after transition to comfort care.


As per this single center retrospective study, the rate of endoscopic procedure-related adverse events and death within 28 d of AA administration appears to be low.

Keywords: Antiangiogenics, Endoscopy, Bevacizumab, Lmatinib, Lenvatinib, Adverse events

Core Tip: This single centered study highlights low adverse events of anti-angiogenics after endoscopic procedures. Currently, the consensus recommends holding anti-angiogenics 28 d prior to the procedure. This small sample study sheds light on the need to hold anti-angiogenics prior to endoscopic procedure and affirms to not delay emergent endoscopic procedures.