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Safety of Endoscopic Procedures in Thrombocytopenia and Neutropenia: Embracing Assurance

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An Invited Commentary to this article was published on 13 May 2024

Abstract

Background

Few studies have evaluated the post-endoscopic adverse events in patients with neutropenia and thrombocytopenia. Current guidelines do not provide clear direction on this topic.

Aim

We explore the pooled rates of safety and adverse effects of endoscopic interventions in thrombocytopenia and neutropenia patients via a systematic review & meta-analysis.

Methods

Databases, including Medline, Scopus, and Embase, were searched (in May 2023) using specific terms for studies evaluating the clinical outcomes of endoscopy in patients with thrombocytopenia and neutropenia. Standard meta-analysis methods were employed using the random-effects model. I2% heterogeneity was used to assess the heterogeneity.

Results

Six studies and four studies evaluated endoscopic outcomes in patients with thrombocytopenia and neutropenia respectively with mean age was 56 years. The pooled rate of total post-biopsy bleeding and total post-polypectomy bleeding among patients with thrombocytopenia was 4% (95% CI 1–11), I2 = 84%, and 12% (95% CI 3–36) I2 = 43%. The total rate of post procedure-related bleeding in thrombocytopenia was 5% (95% CI 1–14) I2 = 95%. The pooled rate of post-endoscopic infection (fever from any cause, bacteremia) in neutropenia was 10% (95% CI 3–28%) I2 = 96%. On sub analysis, the pooled rate of bacteremia and 30 days all-cause mortality in neutropenia was 4% (95% CI 3–5%) I2 = 0% and 13% (95% CI 4–34%) I2 = 95% respectively.

Conclusion

Our data supports the notion that endoscopic procedures are safe for neutropenic, thrombocytopenic patients with suitable indications and reasonable functional status and have an acceptable risk/benefit ratio.

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Abbreviations

GI:

Gastrointestinal

MOOSE:

Meta-analysis of observational studies in epidemiology

PRISMA:

Preferred reporting methods in systematic review and meta-analyses

CI:

Confidence interval

PI:

Prediction interval

OR:

Odds ratio

MD:

Mean difference

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA

    Priyadarshini Loganathan & David Alderman

  2. Gastroenterology & Hepatology, Orlando Gastroenterology PA, Orlando, FL, USA

    Babu P. Mohan

  3. Gastroenterology, University of Texas Health Science Center, San Antonio, TX, USA

    Mahesh Gajendran

  4. Internal Medicine, Saint Peter’s University Hospital, New Brunswick, NJ, USA

    Vishali Moond

  5. Gastroenterology, Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA

    Douglas G. Adler

Authors
  1. Priyadarshini Loganathan
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  4. Mahesh Gajendran
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  5. Vishali Moond
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  6. Douglas G. Adler
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Contributions

BPM, PL, DA: Conception and design. PL, BPM: study search, review, and selection. PL, BPM: data collection and synthesis. PL, BPM: statistical analysis of data and interpretation of results. All authors: Interpretation of the data, drafting of article, critical revision of the article for important intellectual content, and final approval of the manuscript.

Corresponding author

Correspondence to Douglas G. Adler.

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Disclosures

All authors: Disclosure form included.

Conflict of interest

None of the authors have any conflicts of interest.

Ethical approval

This type of study does not involve active human participants and/ or animals; therefore, formal consent, informed consent, institutional review board approval, and ethical approval are not applicable and/ or not required.

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An invited commentary on this article is available at https://doi.org/10.1007/s10620-024-08461-2.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 65 KB)

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Supplementary file2 Supplementary Figure-2: Forest plot: Pooled rate of biopsy-related bleeding with grade II thrombocytopenia (TIF 224 KB)

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Supplementary file3 Supplementary Figure-3: Forest plot: Pooled rate of biopsy-related bleeding with grade III thrombocytopenia (TIF 223 KB)

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Supplementary file4 Supplementary Figure-4: Forest plot: Pooled rate of biopsy-related bleeding with grade IV thrombocytopenia (TIF 224 KB)

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Supplementary file5 Supplementary Figure-5: Forest plot: Pooled rate of procedure-related bleeding in grade II thrombocytopenia (TIF 225 KB)

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Supplementary file6 Supplementary figure- 6: Forest plot: Pooled rate of procedure-related bleeding in grade III thrombocytopenia (TIF 223 KB)

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Supplementary file7 Supplementary figure- 7: Forest plot: Pooled rate of procedure-related bleeding in Grade IV thrombocytopenia (TIF 225 KB)

Supplementary file8 Supplementary figure- 8: Forest plot: Pooled rate of bacteraemia in Neutropenia (TIF 7499 KB)

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Supplementary file9 Supplementary figure- 9: Forest plot: Pooled rate of all-cause mortality in Neutropenia (TIF 7499 KB)

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Loganathan, P., Mohan, B.P., Alderman, D. et al. Safety of Endoscopic Procedures in Thrombocytopenia and Neutropenia: Embracing Assurance. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08467-w

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