Oh Hyun Jin, Park Jae Myung, Yoon Seung Bae, Lee Han Hee, Lim Chul-Hyun, Kim Jin Su, Cho Yu Kyung, Lee Bo-In, Cho Young-Seok, Choi Myung-Gyu
Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea.
Dig Dis Sci. 2017 Mar;62(3):746-754. doi: 10.1007/s10620-016-4427-4. Epub 2016 Dec 29.
Procedure-induced bleeding is a major complication after endoscopic intervention.
The aim of this study was to investigate the risk of endoscopy-related bleeding in patients with chronic hematologic thrombocytopenia.
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.
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 × 10/μl. Multivariate analysis revealed that high-risk procedures and low platelet count (less than 50 × 10/μl) were significantly related to procedure-related bleeding. All bleeding events stopped spontaneously or were controlled with endoscopic hemostasis.
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 × 10/μl or high-risk endoscopic procedures are planned.
手术引发的出血是内镜干预后的主要并发症。
本研究旨在调查慢性血液系统血小板减少症患者内镜检查相关出血的风险。
我们对108例免疫性血小板减少性紫癜或再生障碍性贫血患者进行的175例手术中的内镜检查相关出血情况进行了调查。将结果与年龄、性别和手术匹配的350例对照受试者的手术结果进行比较。内镜干预包括低风险手术，如内镜活检，以及高风险手术，包括息肉切除术、内镜切除术和内镜逆行胰胆管造影术加括约肌切开术。
血小板减少症患者中有17例（9.7%）手术发生出血。该发生率显著高于对照组手术（3.1%，P = 0.003）。约60%的出血事件发生在内镜手术后24小时内。患者组内镜活检后出血的发生率高于对照组（7.1%对0.7%；P < 0.001）。所有高风险手术中有20%发生出血。血小板计数低于50×10⁹/μl的患者出血发生率显著升高。多变量分析显示，高风险手术和低血小板计数（低于50×10⁹/μl）与手术相关出血显著相关。所有出血事件均自行停止或通过内镜止血得到控制。
慢性血液系统血小板减少症患者常发生内镜手术相关出血。对于这些患者，尤其是血小板计数低于50×10⁹/μl或计划进行高风险内镜手术时，应仔细观察术后出血情况。
