Digestive Diseases and Sciences

, Volume 62, Issue 3, pp 746–754 | Cite as

Bleeding After Endoscopic Procedures in Patients With Chronic Hematologic Thrombocytopenia

  • Hyun Jin Oh
  • Jae Myung ParkEmail author
  • Seung Bae Yoon
  • Han Hee Lee
  • Chul-Hyun Lim
  • Jin Su Kim
  • Yu Kyung Cho
  • Bo-In Lee
  • Young-Seok Cho
  • Myung-Gyu Choi
Original Article



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.


Thrombocytopenia 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.

Compliance with ethical standards

Conflict of interests

None to declare.


  1. 1.
    Gaydos LA, Freireich EJ, Mantel N. The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med. 1962;266:905–909.CrossRefPubMedGoogle Scholar
  2. 2.
    Gorschluter M, Schmitz V, Mey U, Hahn-Ast C, Schmidt-Wolf IG, Sauerbruch T. Endoscopy in patients with acute leukaemia after intensive chemotherapy. Leuk Res. 2008;32:1510–1517.CrossRefPubMedGoogle Scholar
  3. 3.
    Krishna SG, Rao BB, Thirumurthi S, et al. Safety of endoscopic interventions in patients with thrombocytopenia. Gastrointest Endosc. 2014;80:425–434.CrossRefPubMedGoogle Scholar
  4. 4.
    Ben-Menachem T, Decker GA, Early DS, et al. Adverse events of upper GI endoscopy. Gastrointest Endosc. 2012;76:707–718.CrossRefPubMedGoogle Scholar
  5. 5.
    Soylu AR, Buyukasik Y, Cetiner D, et al. Overt gastrointestinal bleeding in haematologic neoplasms. Dig Liver Dis. 2005;37:917–922.CrossRefPubMedGoogle Scholar
  6. 6.
    Wandt H, Schaefer-Eckart K, Wendelin K, et al. Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: an open-label, multicentre, randomised study. Lancet. 2012;380:1309–1316.CrossRefPubMedGoogle Scholar
  7. 7.
    Blood TTF. Haematology BCfSi. Guidelines for the use of platelet transfusions. Br J Haematol. 2003;122:10.CrossRefGoogle Scholar
  8. 8.
    Stanworth S, Hyde C, Brunskill S, Murphy M. Platelet transfusion prophylaxis for patients with haematological malignancies: where to now? Br J Haematol. 2005;131:588–595.CrossRefPubMedGoogle Scholar
  9. 9.
    US Department of Health and Human Services. Common terminology criteria for adverse events (CTCAE) version 4.0. Avilabe at: Accessed Jan 14, 2014.
  10. 10.
    Anderson MA, Ben-Menachem T, Gan SI, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009;70:1060–1070.CrossRefPubMedGoogle Scholar
  11. 11.
    Ross WA, Ghosh S, Dekovich AA, et al. Endoscopic biopsy diagnosis of acute gastrointestinal graft-versus-host disease: rectosigmoid biopsies are more sensitive than upper gastrointestinal biopsies. Am J Gastroenterol. 2008;103:982–989.CrossRefPubMedGoogle Scholar
  12. 12.
    Buderus S, Sonderkotter H, Fleischhack G, Lentze MJ. Diagnostic and therapeutic endoscopy in children and adolescents with cancer. Pediatr Hematol Oncol. 2012;29:450–460.CrossRefPubMedGoogle Scholar
  13. 13.
    Kaur S, Cooper G, Fakult S, Lazarus HM. Incidence and outcome of overt gastrointestinal bleeding in patients undergoing bone marrow transplantation. Dig Dis Sci. 1996;41:598–603. doi: 10.1007/BF02282348.CrossRefPubMedGoogle Scholar
  14. 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
  15. 15.
    Cho BS, Yahng SA, Kim JH, et al. Impact of cytomegalovirus gastrointestinal disease on the clinical outcomes in patients with gastrointestinal graft-versus-host disease in the era of preemptive therapy. Ann Hematol. 2013;92:497–504.CrossRefPubMedGoogle Scholar
  16. 16.
    Ponec RJ, Hackman RC, McDonald GB. Endoscopic and histologic diagnosis of intestinal graft-versus-host disease after marrow transplantation. Gastrointest Endosc. 1999;49:612–621.CrossRefPubMedGoogle Scholar
  17. 17.
    Horiuchi A, Nakayama Y, Kajiyama M, Tanaka N, Sano K, Graham DY. Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy. Gastrointest Endosc. 2014;79:417–423.CrossRefPubMedGoogle Scholar
  18. 18.
    Chung IK, Lee JH, Lee SH, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009;69:1228–1235.CrossRefPubMedGoogle Scholar
  19. 19.
    Noda M, Mori N, Nomura K, et al. Regression of idiopathic thrombocytopenic purpura after endoscopic mucosal resection of gastric mucosa associated lymphoid tissue lymphoma. Gut. 2004;53:1698–1700.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lim EJ, Sim EH, Kim BW, et al. Endoscopic submucosal dissection for early gastric cancer in a patient with myelodysplastic syndrome. Korean J Gastroenterol. 2015;65:173–176.CrossRefPubMedGoogle Scholar
  21. 21.
    Slichter SJ, Davis K, Enright H, et al. Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients. Blood. 2005;105:4106–4114.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Hod E, Schwartz J. Platelet transfusion refractoriness. Br J Haematol. 2008;142:348–360.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Hyun Jin Oh
    • 1
  • Jae Myung Park
    • 1
    Email author
  • Seung Bae Yoon
    • 1
  • Han Hee Lee
    • 1
  • Chul-Hyun Lim
    • 1
  • Jin Su Kim
    • 1
  • Yu Kyung Cho
    • 1
  • Bo-In Lee
    • 1
  • Young-Seok Cho
    • 1
  • Myung-Gyu Choi
    • 1
  1. 1.Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea

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