Bleeding After Endoscopic Procedures in Patients With Chronic Hematologic Thrombocytopenia.

Abstract

BACKGROUND:

Procedure-induced bleeding is a major complication after endoscopic intervention.

AIMS:

The aim of this study was to investigate the risk of endoscopy-related bleeding in patients with chronic hematologic thrombocytopenia.

METHODS:

We investigated endoscopy-related bleeding in 175 procedures performed on 108 patients with immune thrombocytopenic purpura or aplastic anemia. The outcomes were compared with those of 350 procedures on age-, sex-, and procedure-matched control subjects. Endoscopic interventions included low-risk procedures such as endoscopic biopsy and high-risk procedures including polypectomy, endoscopic resection, and endoscopic retrograde cholangiopancreatogram with sphincterotomy.

RESULTS:

Bleeding occurred in 17 (9.7%) procedures among the patients with thrombocytopenia. This rate was significantly higher than that in procedures on controls (3.1%, P = 0.003). About 60% of all bleeding events were observed within 24 h after the endoscopic procedure. Bleeding after endoscopic biopsy developed more frequently in the patient group than in the control group (7.1 vs. 0.7%; P < 0.001). Bleeding occurred after 20% of all high-risk procedures. The incidence of bleeding was significantly elevated in patients with a platelet count less than 50 × 103/μl. Multivariate analysis revealed that high-risk procedures and low platelet count (less than 50 × 103/μl) were significantly related to procedure-related bleeding. All bleeding events stopped spontaneously or were controlled with endoscopic hemostasis.

CONCLUSIONS:

Endoscopic procedure-related bleeding develops frequently in patients with chronic hematologic thrombocytopenia. Post-procedural bleeding should be observed carefully in these patients, especially when the platelet count is less than 50 × 103/μl or high-risk endoscopic procedures are planned.

• Authors: Hyun Jin Oh, Jae Myung Park, Seung Bae Yoon, Han Hee Lee, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho, Bo-In Lee, Young-Seok Cho, Myung-Gyu Choi
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 62 Issue 3 Pg. 746-754 (03 2017) ISSN: 1573-2568 [Electronic] United States
• PMID: 28035550 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Anemia, Aplastic (complications)
• Endoscopy, Gastrointestinal (adverse effects, methods, statistics & numerical data)
• Female
• Gastrointestinal Diseases (complications, diagnosis, surgery)
• Gastrointestinal Hemorrhage (diagnosis, epidemiology, etiology, therapy)
• Hemostasis, Endoscopic (methods)
• Humans
• Male
• Postoperative Hemorrhage (diagnosis, epidemiology, etiology, therapy)
• Purpura, Thrombocytopenic (complications)
• Remission, Spontaneous
• Republic of Korea (epidemiology)
• Risk Assessment (methods)
• Risk Factors
• Thrombocytopenia (blood, etiology)