Endoscopy in neutropenic and/or thrombocytopenic patients

Table 3 Thrombocytopenic precautions, therapeutic interventions, and bleeding adverse events

Study	Thrombocytopenic precautions	Therapeutic intervention	Bleeding Adverse events
	n = No. thrombocytopenic patients
Buderus et al[19]	Platelets < 30000/mm3: Biopsies not taken	4 PEG tube placements	None
	n = 12 (Platelets < 50000/mm3; 3 of 12 had platelets < 30000/mm3)	1 PEG tube removal
		2 sclerotherapies for varices
		6 NJ tubes placement
Chu et al[17]	Platelets < 20000/mm3: Biopsies not performed	None	None
	Platelet transfusion not a prerequisite, but made available
	n = 44 (Platelets < 40000/mm3; 25 of 44 had platelets < 20000/mm3)
Gorschlüter et al[20]	Platelets < 10000/mm3: Prophylactic platelet transfusion	8 endoscopic hemostasis in upper exam, including:	2 of 106 (1.9%) primary upper EGD had proven adverse events: hemorrhage induced by EGD (one stopped bleeding spontaneously and the other one required injection
	n = unknown	5 used fibrin glue
	Median platelets 23000/mm3	2 used fibrin glue plus epinephrine
		1 used epinephrine alone
		ERCP in 5 patients
		Duodenal tube placement in 8 patients	No ERCP-related adverse events
Kaur et al[22]	Platelets < 50000/mm3:	2 patients underwent successful electrocautery for bleeding ulcers	10 of the 31 patients in which endoscopies were performed had recurrent bleed at median of 7 d after index bleed (range 2-27 d), none readmitted
	Prophylactic platelet transfusion
	No target platelet count sought
	For all patients:
	Prophylaxis with H2 blockers or sucralfate or both		No adverse events as a result of endoscopy
	Hematopoietic cell progenitor support
	n = 27 (Platelets < 50000/mm3)
Kaur et al[23]	None	11 PEG tube placements	None reported
	n = unknown
Khan et al[24]	For platelets < 50000/mm3: Platelets transfused during procedure	None	GI bleeding adverse events occurred in 12 procedures out of 418 total procedures (2.9%). Thrombocytopenia was significantly associated (P < 0.01) with bleeding, occurring in 10 of the 12 procedures with bleeding adverse events
	n = 111 (Platelets < 50000/mm3)
			8 cases of bleeding events following EGD, of which there were:
			4 cases of duodenal hematomas that resolved with conservative management
			1 case requiring repeat endoscopy with electrocautery
			3 cases of acute GVHD managed conservatively
			4 cases of bleeding events following lower endoscopy"
			All due to acute GVHD
			Appear to have been managed conservatively
Park et al[21]	For platelets < 5000/mm3 or unstable (fever, hemorrhagic signs) patients with a platelet < 10000/mm3:	3 patients successfully treated with argon plasma coagulation for gastric angiodysplasia, hemoclips on colon ulcer, hemoclips on duodenal Dieulafoy’s lesion	1 death from massive GI bleed
			Re-bleed of Dieulafoy lesion, successfully treated by re-clipping
	Prophylactic platelet transfusion		No adverse events attributable to endoscopy
	n = unknown
Ross et al[25]	For platelets < 25-50000/mm3:	None	None reported
	Prophylactic platelet transfusion at discretion of endoscopist
	44 patients received prophylactic platelet transfusion
	n = at least 44 (Platelets < 25000-50000)
Schulenburg et al[26]	For platelets < 50000/mm3: Prophylactic platelet transfusion	None	None
	Platelet support to maintain count > 20000/mm3
	n = unknown
Schwartz et al[18]	For platelets < 50000/mm3:	2 attempted endoscopic hemostasis	No adverse events attributable to endoscopy reported
	No endoscopy if 50000/mm3 not reached	1 injection successful
	n = unknown	1 bipolar cautery plus injection that was unsuccessful and required surgery
Soylu et al[27]	For platelets < 20000/mm3:	None	No deaths or adverse events attributable to endoscopy
	Prophylactic platelet transfusion
	Active bleeding with higher platelet count also received prophylactic transfusion
	Severe thrombocytopenia (level not defined):
	EGD withheld in 17 of 25 upper GI bleeding episodes
	Colonoscopy withheld in 7 lower GI bleeding episodes
	n = unknown

GI: Gastrointestinal; EGD: Esophagogastroduodenoscopy; PEG: Percutaneous endoscopic gastrostomy; GVHD: Graft-vs-host disease.