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对严重血小板减少的血液系统恶性肿瘤患者进行内镜干预:方法学问题、临床意义及未来研究方向

Endoscopic intervention in hematologic malignancy patients with severe thrombocytopenia: Methodological concerns, clinical implications, and future research directions.

作者信息

Krishnan Arunkumar

机构信息

Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, NC 28204, United States.

出版信息

World J Gastrointest Endosc. 2025 Apr 16;17(4):105630. doi: 10.4253/wjge.v17.i4.105630.

Abstract

Gastrointestinal bleeding (GIB) presents a significant challenge for patients with hematologic malignancies, especially those with severe thrombocytopenia. Although endoscopic intervention is frequently used in managing GIB, its safety and effectiveness in this high-risk group remain unclear. A recent study by Alhumayyd provided insight into this issue. However, it has notable limitations, including its retrospective nature, small sample size, and failure to adjust for important confounding factors such as disease severity, hemodynamic status, and platelet function. The study's findings indicated that urgent endoscopy may help decrease the incidence of recurrent bleeding; however, it did not show a clear benefit in terms of mortality. Future research ought to prioritize prospective, multicenter studies that employ standardized protocols and incorporate risk stratification models to better understand the impact of endoscopic treatment for GIB in these patients. Additionally, integrating platelet function assays could improve clinical decision-making. Addressing these research gaps is essential for improving patient outcomes and developing effective guidelines for managing GIB in individuals with thrombocytopenia.

摘要

胃肠道出血(GIB)对血液系统恶性肿瘤患者,尤其是严重血小板减少的患者构成了重大挑战。尽管内镜干预常用于治疗GIB,但其在这一高危人群中的安全性和有效性仍不明确。Alhumayyd最近的一项研究为这个问题提供了见解。然而,它有显著的局限性,包括其回顾性性质、样本量小,以及未能对疾病严重程度、血流动力学状态和血小板功能等重要混杂因素进行调整。该研究的结果表明,紧急内镜检查可能有助于降低再出血的发生率;然而,在死亡率方面并没有显示出明显的益处。未来的研究应该优先进行前瞻性、多中心研究,采用标准化方案并纳入风险分层模型,以更好地了解内镜治疗对这些患者GIB的影响。此外,整合血小板功能检测可以改善临床决策。填补这些研究空白对于改善患者预后以及制定血小板减少症患者GIB管理的有效指南至关重要。

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