Endoscopy in neutropenic and/or thrombocytopenic patients

Table 4 Neutropenic precautions and infectious adverse events

Study	Neutropenic precautions	Infectious adverse events
	n = No. of afebrile neutropenic patients
Buderus et al[19]	ANC < 1000/mm3 threshold:	One (2.1%) procedure-related adverse event:
	Upper endoscopies performed under “aseptic conditions” (not defined), appears that this did not include antibiotic prophylaxis	Fever and abdominal tenderness after colonoscopy
	Colonoscopies performed under antibiotic prophylaxis n = 10 (ANC < 1000/mm3)	Patient had not received antibiotic prophylaxis despite neutropenia (ANC 490/mm3); no explanation given in article
		Symptoms resolved in 2 d under IV antibiotics
Chu et al[17]	None	None
	n = unknown
Gorschlüter et al[20]	Neutropenia not defined	16 of 106 (15%) primary upper EGD: Fever within 48 h
	n = unknown	3 of 20 (15%) primary colonoscopies: Fever within 48 h
	Median WBC 1.5 G/l	Total # patients with fever following endoscopy: 19.
		5 of these died within 10 d.
		Not significantly different from # patients who died without having a fever following endoscopy.
		No ERCP-related adverse events
Kaur et al[22]	Neutropenia not defined	2 deaths due to sepsis
	n = unknown	No adverse events attributed to endoscopy
Kaur et al[23]	No neutropenic precautions taken	4 (36%) infectious adverse events total (both neutropenic and non-neutropenic)
	n = 4 (ANC < 1500/mm3)
		2 patients neutropenic at time of PEG placement.
		First patient had cellulitis and small abscess at PEG site, treated by removal of PEG
		Second patient had cellulitis at PEG site, treated by IV antibiotics
		2 patients non-neutropenic at time of PEG placement, but had neutropenia at the time of infection
Khan et al[24]	For ANC < 1000/mm3:	No infectious adverse events related to endoscopy.
	Broad-spectrum antibiotics prophylaxis	1 colonic perforation resulting in death
	n = 148 (WBC < 4000/mm3)
Park et al[21]	“Severe aplastic anemia” defined as bone marrow cellularity less than 25% and very low values for at least 2 of 3 hematopoietic lineages (including ANC < 500/mm3)	No adverse events attributable to endoscopy
	No precautions (no patients with fever)
	n = 28 (Severe aplastic anemia)
Ross et al[25]	None	None reported
	n = 0
Schulenburg et al[26]	Antibiotic prophylaxis during aplasia for all patients	None
	No extra prophylaxis for endoscopy
Schwartz et al[18]	None	No adverse events attributable to endoscopy
	n = unknown
Soylu et al[27]	Severe neutropenia (level not defined):	No adverse events attributable to endoscopy
	Withhold endoscopy in 17 upper and 7 lower GI bleed episodes
	n = unknown

EGD: Esophagogastroduodenoscopy; PEG: Percutaneous endoscopic gastrostomy; ERCP: Endoscopic retrograde cholangiopancreatography; GI: Gastrointestinal.