In the course of aggressive treatment for acute
leukemia, the ensuing
pancytopenia and intensive medical support may be accompanied by severe gastrointestinal (GI) complications. Therefore, to assess the safety and efficacy of GI endoscopy as a means of diagnosis, we analyzed the records of 16 patients undergoing 27 endoscopies a mean (+/-S.D.) of 18.4 +/- 11.9 days post
chemotherapy. There were 6 procedures performed in patients with acute lymphocytic, 18 with acute myelogenous, including 3 with acute promyelocytic and 3 with blastic phase
chronic myelogenous leukemia. 10/27 procedures were performed in patients with less than 1000 WBC/mm3 and 19/27 had less than 100,000 platelets. 15 patients had 25 upper endoscopies done for:
bleeding (twenty-one),
abdominal pain (two), and persistent
vomiting (two). The principal
bleeding sources were:
esophagitis (eleven),
Mallory Weiss tear (one),
gastritis (three),
gastric ulcer (one),
duodenal ulcer (five). In the non-
bleeding cases 2 exams were normal and the others had
gastritis (one) and
esophagitis (one). 15/25 procedures (64%) resulted in new diagnosis and 20/25 (80%) in additional
therapies. 47% of patients undergoing upper GI endoscopy received specific new
therapies as a result of that procedure.
Nd: YAG laser photocoagulation was effective in stopping
bleeding lesions in 4/6 cases. 10/12
bleeding patients had persistent or recurrent
bleeding and 2 died from
bleeding. None had surgery. Two patients underwent colonoscopy, both for colonic distention. One patient, who had been recently treated for Cl. difficile had submucosal
petechiae. The other had non-specific
colitis. No biopsies were done and both cases were successfully decompressed..No complications occurred from any GI endoscopy. We conclude that GI endoscopy can be safely performed in patients with acute
leukemia, resulting in specific diagnoses and
therapies.
Esophagitis is a principal cause of GI
bleeding in these patients. The role of therapeutic endoscopy in controlling
bleeding is promising but requires further evaluation.