PMID- 30550744 OWN - NLM STAT- MEDLINE DCOM- 20191202 LR - 20191202 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 89 IP - 5 DP - 2019 May TI - Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia. PG - 937-949.e2 LID - S0016-5107(18)33347-9 [pii] LID - 10.1016/j.gie.2018.12.004 [doi] AB - BACKGROUND AND AIMS: Cancer patients are prone to thrombocytopenia and neutropenia, which increase the risk of bleeding and infection. We assessed the safety of endoscopic procedures in cancer patients with thrombocytopenia and/or neutropenia. METHODS: We studied consecutive cancer patients with thrombocytopenia and/or neutropenia who underwent endoscopic procedures from 2010 through 2015. Neutropenia was defined as an absolute neutrophil count (ANC) <1000 cells/muL, and thrombocytopenia as a platelet count <100 x 10(3)/muL. Univariate and multivariate generalized estimating equation models were used to assess factors associated with risk of adverse events (AEs) or death. RESULTS: We identified 588 patients who underwent 783 procedures; 608 procedures were performed in the setting of thrombocytopenia and 675 procedures in the setting of neutropenia. Concurrent neutropenia and thrombocytopenia were recorded in 500 endoscopies. Twenty-four patients (4.1%) experienced infectious AEs, whereas 29 (4.9%) experienced bleeding AEs within 1 week of the procedure. On multivariate analysis, platelet count 20 x 10(3)/muL after the procedure (P < .01); furthermore, if the platelet count increased to >50 x 10(3)/muL after the procedure, the bleeding risk after the procedure was greatly reduced (P < .01). CONCLUSIONS: Endoscopic procedures are relatively safe in cancer patients with platelet count >50 x 10(3)/muL. Nevertheless, a platelet count of >/=20 x 10(3)/muL could be an appropriate threshold for platelet transfusion if 50 x 10(3)/muL is difficult to achieve. The functional status of the patient, in the absence of the need for urgent or necessary endoscopic interventions, should be considered when deciding whether to perform endoscopy. The risk of procedure and the ANC did not seem to affect the outcomes. CI - Copyright (c) 2019 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Abu-Sbeih, Hamzah AU - Abu-Sbeih H AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Ali, Faisal Shaukat AU - Ali FS AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Coronel, Emmanuel AU - Coronel E AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Chen, Hsiang-Chun AU - Chen HC AD - Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Wang, Xuemei AU - Wang X AD - Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Lum, Phillip AU - Lum P AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Shuttlesworth, Gladis AU - Shuttlesworth G AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Bhutani, Manoop S AU - Bhutani MS AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Raju, Gottumukkala S AU - Raju GS AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Lee, Jeffrey H AU - Lee JH AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Stroehlein, John R AU - Stroehlein JR AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Ross, William A AU - Ross WA AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Wang, Yinghong AU - Wang Y AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. LA - eng PT - Comparative Study PT - Journal Article DEP - 20181211 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 SB - IM MH - Academic Medical Centers MH - Age Factors MH - Aged MH - Analysis of Variance MH - Cohort Studies MH - Comorbidity MH - Digestive System Neoplasms/*surgery MH - Endoscopy, Digestive System/*adverse effects/methods MH - Female MH - Gastrointestinal Hemorrhage/*etiology MH - Humans MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Neutropenia/diagnosis/*epidemiology MH - Patient Safety/*statistics & numerical data MH - Prognosis MH - Retrospective Studies MH - Risk Assessment MH - Sex Factors MH - Survival Rate MH - Thrombocytopenia/diagnosis/*epidemiology EDAT- 2018/12/15 06:00 MHDA- 2019/12/04 06:00 CRDT- 2018/12/15 06:00 PHST- 2018/03/10 00:00 [received] PHST- 2018/12/02 00:00 [accepted] PHST- 2018/12/15 06:00 [pubmed] PHST- 2019/12/04 06:00 [medline] PHST- 2018/12/15 06:00 [entrez] AID - S0016-5107(18)33347-9 [pii] AID - 10.1016/j.gie.2018.12.004 [doi] PST - ppublish SO - Gastrointest Endosc. 2019 May;89(5):937-949.e2. doi: 10.1016/j.gie.2018.12.004. Epub 2018 Dec 11.