Mortality and Infectious Adverse Events in Neutropenic Patients Undergoing Gastrointestinal Endoscopic Procedures: A...

The safety of gastrointestinal endoscopy in neutropenic patients remains unestablished. Gastrointestinal and infectious disease society guidelines indicate that infectious adverse events are increased after endoscopy in neutropenic patients. We performed a systematic review and meta-analysis to assess the safety of endoscopy in neutropenic patients.

Cochrane Library, Embase, Google Scholar, MEDLINE, PubMed, Scopus, and Web of Science were searched through September 2025 for studies in neutropenic patients (absolute neutrophil count <1000 cells/μL) undergoing endoscopy with outcome data on infections, mortality, or fever. Conference abstracts from January 2017 to September 2025 were also searched. Two reviewers independently identified studies meeting inclusion criteria, performed data extraction, and assessed risk of bias. Coprimary outcomes were 30-day infection-related mortality and infectious adverse events within 7 days of endoscopy. Secondary outcomes were new bacteremia and new fever within 7 days of endoscopy. Random-effects meta-analyses were performed.

Six cohort studies met eligibility criteria (N = 1241 patients). Pooled incidence was 0.0% (95% confidence interval [CI] 0.00%-0.03%; I² = 0.0%) for infection-related mortality and 7.3% (95% CI 0.00%-25.57%; I² = 98.6%) for infectious adverse events, which consisted of bacteremia (2.4% [95% CI 0.03%-6.99%; I² = 87.3%]) and new fever (4.8% [95% CI 0.00%-9.74%; I² = 99%]). Preprocedural antibiotic use did not reduce infectious adverse events or bacteremia as compared to no antibiotic use: odds ratio = 2.97, 95% CI 0.47-18.67.

Infection-related mortality within 30 days was 0% and infectious adverse events within 7 days occurred in 7.3% of neutropenic patients undergoing endoscopy. These findings suggest endoscopy maybe safely performed in appropriately selected neutropenic patients.