Bleeding After Endoscopic Procedures in Patients With Chronic Hematologic Thrombocytopenia
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Procedure-induced bleeding is a major complication after endoscopic intervention.
The aim of this study was to investigate the risk of endoscopy-related bleeding in patients with chronic hematologic thrombocytopenia.
We investigated endoscopy-related bleeding in 175 procedures performed on 108 patients with immune thrombocytopenic purpura or aplastic anemia. The outcomes were compared with those of 350 procedures on age-, sex-, and procedure-matched control subjects. Endoscopic interventions included low-risk procedures such as endoscopic biopsy and high-risk procedures including polypectomy, endoscopic resection, and endoscopic retrograde cholangiopancreatogram with sphincterotomy.
Bleeding occurred in 17 (9.7%) procedures among the patients with thrombocytopenia. This rate was significantly higher than that in procedures on controls (3.1%, P = 0.003). About 60% of all bleeding events were observed within 24 h after the endoscopic procedure. Bleeding after endoscopic biopsy developed more frequently in the patient group than in the control group (7.1 vs. 0.7%; P < 0.001). Bleeding occurred after 20% of all high-risk procedures. The incidence of bleeding was significantly elevated in patients with a platelet count less than 50 × 103/μl. Multivariate analysis revealed that high-risk procedures and low platelet count (less than 50 × 103/μl) were significantly related to procedure-related bleeding. All bleeding events stopped spontaneously or were controlled with endoscopic hemostasis.
Endoscopic procedure-related bleeding develops frequently in patients with chronic hematologic thrombocytopenia. Post-procedural bleeding should be observed carefully in these patients, especially when the platelet count is less than 50 × 103/μl or high-risk endoscopic procedures are planned.
KeywordsThrombocytopenia Endoscopic procedure Bleeding Aplastic anemia Immune thrombocytopenic purpura
This research was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (NRF-2013R1A1A2007985) and by the program of Global Research and Development Center through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (NRF-2011-0031644). All authors have no conflicts of interest or financial ties to disclose.
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Conflict of interests
None to declare.
- 9.US Department of Health and Human Services. Common terminology criteria for adverse events (CTCAE) version 4.0. Avilabe at: http://www.evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf. Accessed Jan 14, 2014.
- 14.Khan K, Schwarzenberg SJ, Sharp H, et al. Diagnostic endoscopy in children after hematopoietic stem cell transplantation. Gastrointest Endosc. 2006;64:379–385; quiz 389–392.Google Scholar