Alhumayyd B, Naumann A, Cashen A, Chen CH. Clinical impact of endoscopy in severely thrombocytopenic patients with hematologic malignancy experiencing gastrointestinal bleeding. World J Gastrointest Endosc 2025; 17(2): 102532 [DOI: 10.4253/wjge.v17.i2.102532]
Corresponding Author of This Article
Badr Alhumayyd, MD, Assistant Professor, Department of Gastroenterology, King Saud University, 11495 King Abdulla Street, Riyadh 22480, Ar-Riyāḍ, Saudi Arabia. balhumayyd@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
Badr Alhumayyd, Department of Gastroenterology, King Saud University, Riyadh 22480, Ar-Riyāḍ, Saudi Arabia
Ashton Naumann, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States
Amanda Cashen, Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States
Chien-Huan Chen, Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, United States
Author contributions: Alhumayyd B collected and analyzed the data, wrote the sections related to material and methods, statistical analysis and results along with editing and reviewing the manuscript; Naumann A contributed to writing and editing the manuscript; Cashen A contributed to the research methodology along with reviewing the manuscript; Chen CH reviewed the data and edited the manuscript for the final approval.
Institutional review board statement: This study was approved by the Washington University in St. Louis Institutional Review Board.
Informed consent statement: This project has been granted a waiver of HIPAA Authorization per section 164.512(i) of the Privacy Rule to allow the research team to use Protected Health Information (PHI) in the context of this research study. This determination is based on the documentation provided by the researcher in the IRB application and the assurance document signed by the Principal Investigator.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at balhumayyd@gmail.com. The presented data are anonymized with no risk of identification.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Badr Alhumayyd, MD, Assistant Professor, Department of Gastroenterology, King Saud University, 11495 King Abdulla Street, Riyadh 22480, Ar-Riyāḍ, Saudi Arabia. balhumayyd@gmail.com
Received: October 21, 2024 Revised: December 26, 2024 Accepted: January 14, 2025 Published online: February 16, 2025 Processing time: 115 Days and 5.9 Hours
Abstract
BACKGROUND
Gastrointestinal bleeding (GIB) is a major cause of hospitalization worldwide. Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction. There is no consensus on the optimal platelet level that would be safe for endoscopic intervention, although a platelet level of > 50 × 109 / L was suggested based on expert opinion. There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.
AIM
To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.
METHODS
This is a single center retrospective study. The data was collected from the electronic health record from 2018 to 2020. Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count ≤ 50 × 109/L were included in the study. Outcomes included mortality, transfusion requirements, length of stay, intensive care unit admission and recurrent bleeding. A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy > 24 hours.
RESULTS
A total of 76 patients were identified. The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm. There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day (P = 0.13) or 1 year (P = 0.78) mortality, recurrent bleeding (P = 0.68), transfusion of red blood cells (P = 0.47), platelets (P = 0.31), or length of stay (P = 0.94). A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality (P = 0.11 and 0.46, respectively) compared to routine endoscopy, but was associated with decreased recurrent bleeding in 30 days (P = 0.01).
CONCLUSION
Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.
Core Tip: Hematologic malignancies have a higher risk of diffuse gastrointestinal bleeding (GIB) related to severe thrombocytopenia and platelet dysfunction. It is unclear if endoscopy impacts the management of these patients. In this study, we investigated whether endoscopy improved the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB compared to conservative management. Our results show no statistical difference in mortality, recurrent bleeding and length of stay between endoscopic and conservative management. However, endoscopy within 24 hours of GIB significantly reduced the 30-day recurrent bleeding rate compared to endoscopy performed > 24 hours.
