Azam Mohammad, Hudgi Amit, Uy Pearl Princess, Makhija Jinal, Yap John Erikson L
Department of Internal Medicine, Medical College of Georgia/Augusta University, Augusta, GA 30912, United States.
Division of Gastroenterology, Medical College of Georgia/Augusta University, Augusta, GA 30912, United States.
World J Gastrointest Endosc. 2022 Jul 16;14(7):416-423. doi: 10.4253/wjge.v14.i7.416.
Antiangiogenic agents (AAs) are increasingly used to treat malignant tumors and have been associated with gastrointestinal (GI) bleeding and perforation. Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment. Data regarding the safety of endoscopy while on antiangiogenic agents is extremely limited. No guidelines are in place to address the concern about withholding these anti-angiogenic drugs.
To evaluate the risks of endoscopy in patients on antiangiogenic agents from 2015 to 2020 at our institution.
This is a single centered retrospective study approved by the institutional review board statement of the institution. Patients that underwent endoscopy within 28 d of antiangiogenic agents' treatment were included in the study. Primary outcome of interest was death, and secondary outcomes included perforation and GI bleeding. Data were analyzed utilizing descriptive statistics. Fifty-nine patients were included in the final analysis and a total of eighty-five procedures were performed that were characterized as low risk and high risk.
Among the 59 patients a total of 85 endoscopic procedures were performed with 24 (28.2%) categorized as high-risk and 61 (71.8%) procedures as low-risk. Of the total number of patients, (50%) were on bevacizumab and the rest were on imatinib (11.7%), lenvatinib (6.7%) and, ramucirumab (5%). The average duration between administration of AAs and the performance of endoscopic procedures was 9.9 d. No procedure-related adverse events were noted among our study population. We did observe two deaths with one patient, on lenvatinib for metastatic hepatocellular carcinoma, who had persistent bleeding despite esophageal variceal banding and died 4 d later from hemorrhagic shock. Another patient was diagnosed with acute myeloid leukemia died 24 d after an esophagogastroduodenoscopy with biopsy after transition to comfort care.
As per this single center retrospective study, the rate of endoscopic procedure-related adverse events and death within 28 d of AA administration appears to be low.
抗血管生成药物（AAs）越来越多地用于治疗恶性肿瘤，且与胃肠道（GI）出血和穿孔有关。建议择期手术和内镜检查推迟31天，直到抗血管生成药物治疗结束后进行。关于在使用抗血管生成药物期间进行内镜检查安全性的数据极为有限。目前尚无指南来解决停用这些抗血管生成药物的相关问题。
评估2015年至2020年在我们机构使用抗血管生成药物的患者进行内镜检查的风险。
这是一项经机构机构审查委员会声明批准的单中心回顾性研究。在抗血管生成药物治疗28天内接受内镜检查的患者纳入研究。主要关注结局是死亡，次要结局包括穿孔和胃肠道出血。数据采用描述性统计进行分析。最终分析纳入了59例患者，共进行了85例手术，分为低风险和高风险。
59例患者共进行了85例内镜手术，其中24例（28.2%）为高风险手术，61例（71.8%）为低风险手术。在所有患者中，50%使用贝伐单抗，其余患者使用伊马替尼（11.7%）、乐伐替尼（6.7%）和雷莫西尤单抗（5%）。抗血管生成药物给药与内镜手术之间的平均间隔时间为9.9天。在我们的研究人群中未观察到与手术相关的不良事件。我们确实观察到两例死亡，一例使用乐伐替尼治疗转移性肝细胞癌的患者，尽管进行了食管静脉曲张套扎术仍持续出血，4天后死于失血性休克。另一例患者被诊断为急性髓系白血病，在接受食管胃十二指肠镜检查及活检后转为舒适护理，24天后死亡。
根据这项单中心回顾性研究，在抗血管生成药物给药28天内，内镜手术相关不良事件和死亡发生率似乎较低。
