Risks of GI endoscopy in cancer patients with neutropenia and thrombocytopenia

We evaluated the safety of endoscopic procedures in cancer patients with neutropenia and/or thrombocytopenia.

We collected data on patients with neutropenia and/or thrombocytopenia who underwent endoscopy between 2012 and 2022 at Roswell Park Comprehensive Cancer Center. Neutropenia was defined as absolute neutrophil count (ANC) <1500 cells/µL, and thrombocytopenia was defined as platelet count <50 x 10³/µL. The development of infectious AEs (fever within 3 days or positive blood cultures within 7 days following endoscopy) in neutropenic patients and bleeding AEs (new overt GI bleeding within 3 days following endoscopy) in thrombocytopenic patients were the primary outcome measures; 30-day mortality was a secondary outcome measure. Univariate and multivariate analyses by logistic regressions were used to evaluate for risk factors.

A total of 234 patients who underwent 329 endoscopic procedures were identified. In neutropenic patients, 7.8% (8/103) developed infectious AEs. In thrombocytopenic patients, 5.8% (12/208) developed bleeding AEs. Use of granulocyte colony-stimulating factor (G-CSF) was associated with increased risk of infectious AEs (OR 5.79, p = 0.02). The severity of neutropenia or thrombocytopenia and risk level of endoscopy were not associated with AEs. Multivariate analyses showed that poor performance status (PS) was the greatest risk factor for increased 30-day mortality (OR 4.69, p = <0.01).

Endoscopy in patients with neutropenia and thrombocytopenia is relatively safe and does not lead to significant morbidity. A careful risk-benefit analysis in cancer patients with poor PS should be conducted prior to endoscopy.