Endoscopy in Cancer Patients With Thrombocytopenia and/or Neutropenia: Deny or Embrace?

Gastroenterologists are often consulted to perform endoscopy in oncology patients with thrombocytopenia and/or neutropenia. Guidelines vary in their recommendations on the minimal threshold of platelet counts as well as absolute neutrophil counts needed to safely perform endoscopic procedures. This large retrospective single-center study assessed the safety of endoscopic procedures in cancer patients with thrombocytopenia and/or neutropenia. 

This study identified 588 consecutive cancer patients between 2010 and 2015 who underwent at least one endoscopic procedure in the setting of thrombocytopenia (n=608) and/or neutropenia (n=675).  Thrombocytopenia was defined as severe (<20 x 103/µL), moderate (20-50 x 103/µL), or mild (50-100 x 103/µL). Neutropenia was defined as severe (<200 cells/µL), moderate (200-500 cells/µL), or mild (500-1,000 cells/µL). Primary outcomes included adverse events (AEs) (such as bleeding or infectious complications) within one week of endoscopy. Secondary outcome was 30-day mortality. In regards to bleeding, multivariate analysis determined that moderate and severe thrombocytopenia (<50 x 103/µL) independently contributed to a higher risk of bleeding AEs (P=0.05 and P=0.02, respectively). Performance of biopsy did not appear to contribute to bleeding. In regards to infections, univariate analysis suggested that the degree of neutropenia was not associated with increased infectious AEs. Poor performance status (ECOG 3 or above) independently contributed to a higher risk of infectious AEs (P<0.01) and the use of prophylactic antibiotics did not decrease infectious complications. Both poor performance status as well as any degree of thrombocytopenia independently contributed to a higher risk of 30-day mortality.