Loganathan Priyadarshini, Mohan Babu P, Alderman David, Gajendran Mahesh, Moond Vishali, Adler Douglas G
Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA.
Gastroenterology & Hepatology, Orlando Gastroenterology PA, Orlando, FL, USA.
Dig Dis Sci. 2024 Jul;69(7):2354-2362. doi: 10.1007/s10620-024-08467-w. Epub 2024 May 13.
Few studies have evaluated the post-endoscopic adverse events in patients with neutropenia and thrombocytopenia. Current guidelines do not provide clear direction on this topic.
We explore the pooled rates of safety and adverse effects of endoscopic interventions in thrombocytopenia and neutropenia patients via a systematic review & meta-analysis.
Databases, including Medline, Scopus, and Embase, were searched (in May 2023) using specific terms for studies evaluating the clinical outcomes of endoscopy in patients with thrombocytopenia and neutropenia. Standard meta-analysis methods were employed using the random-effects model. I% heterogeneity was used to assess the heterogeneity.
Six studies and four studies evaluated endoscopic outcomes in patients with thrombocytopenia and neutropenia respectively with mean age was 56 years. The pooled rate of total post-biopsy bleeding and total post-polypectomy bleeding among patients with thrombocytopenia was 4% (95% CI 1-11), I = 84%, and 12% (95% CI 3-36) I = 43%. The total rate of post procedure-related bleeding in thrombocytopenia was 5% (95% CI 1-14) I = 95%. The pooled rate of post-endoscopic infection (fever from any cause, bacteremia) in neutropenia was 10% (95% CI 3-28%) I = 96%. On sub analysis, the pooled rate of bacteremia and 30 days all-cause mortality in neutropenia was 4% (95% CI 3-5%) I = 0% and 13% (95% CI 4-34%) I = 95% respectively.
Our data supports the notion that endoscopic procedures are safe for neutropenic, thrombocytopenic patients with suitable indications and reasonable functional status and have an acceptable risk/benefit ratio.
很少有研究评估中性粒细胞减少和血小板减少患者的内镜检查后不良事件。目前的指南在这个问题上没有提供明确的指导。
我们通过系统评价和荟萃分析，探讨血小板减少和中性粒细胞减少患者内镜干预的安全性和不良反应的合并发生率。
在2023年5月检索了包括Medline、Scopus和Embase在内的数据库，使用特定术语查找评估血小板减少和中性粒细胞减少患者内镜检查临床结果的研究。采用随机效应模型的标准荟萃分析方法。用I²异质性评估异质性。
六项研究和四项研究分别评估了血小板减少和中性粒细胞减少患者的内镜检查结果，平均年龄为56岁。血小板减少患者活检后总出血率和息肉切除术后总出血率分别为4%（95%CI 1-11），I²=84%，以及12%（95%CI 3-36），I²=43%。血小板减少患者术后相关总出血率为5%（95%CI 1-14），I²=95%。中性粒细胞减少患者内镜检查后感染（任何原因引起的发热、菌血症）的合并发生率为10%（95%CI 3-28%），I²=96%。亚组分析显示，中性粒细胞减少患者菌血症和30天全因死亡率的合并发生率分别为4%（95%CI 3-5%），I²=0%和13%（95%CI 4-34%），I²=95%。
我们的数据支持这样一种观点，即对于有合适适应证和合理功能状态的中性粒细胞减少、血小板减少患者，内镜检查是安全的，且风险/效益比可接受。
