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Bleeding After Endoscopic Procedures in Patients With Chronic Hematologic Thrombocytopenia

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Abstract

Background

Procedure-induced bleeding is a major complication after endoscopic intervention.

Aims

The aim of this study was to investigate the risk of endoscopy-related bleeding in patients with chronic hematologic thrombocytopenia.

Methods

We investigated endoscopy-related bleeding in 175 procedures performed on 108 patients with immune thrombocytopenic purpura or aplastic anemia. The outcomes were compared with those of 350 procedures on age-, sex-, and procedure-matched control subjects. Endoscopic interventions included low-risk procedures such as endoscopic biopsy and high-risk procedures including polypectomy, endoscopic resection, and endoscopic retrograde cholangiopancreatogram with sphincterotomy.

Results

Bleeding occurred in 17 (9.7%) procedures among the patients with thrombocytopenia. This rate was significantly higher than that in procedures on controls (3.1%, P = 0.003). About 60% of all bleeding events were observed within 24 h after the endoscopic procedure. Bleeding after endoscopic biopsy developed more frequently in the patient group than in the control group (7.1 vs. 0.7%; P < 0.001). Bleeding occurred after 20% of all high-risk procedures. The incidence of bleeding was significantly elevated in patients with a platelet count less than 50 × 103/μl. Multivariate analysis revealed that high-risk procedures and low platelet count (less than 50 × 103/μl) were significantly related to procedure-related bleeding. All bleeding events stopped spontaneously or were controlled with endoscopic hemostasis.

Conclusions

Endoscopic procedure-related bleeding develops frequently in patients with chronic hematologic thrombocytopenia. Post-procedural bleeding should be observed carefully in these patients, especially when the platelet count is less than 50 × 103/μl or high-risk endoscopic procedures are planned.

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Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (NRF-2013R1A1A2007985) and by the program of Global Research and Development Center through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (NRF-2011-0031644). All authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea

    Hyun Jin Oh, Jae Myung Park, Seung Bae Yoon, Han Hee Lee, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho, Bo-In Lee, Young-Seok Cho & Myung-Gyu Choi

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  1. Hyun Jin Oh
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  2. Jae Myung Park
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  3. Seung Bae Yoon
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  4. Han Hee Lee
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  5. Chul-Hyun Lim
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  6. Jin Su Kim
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  7. Yu Kyung Cho
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  8. Bo-In Lee
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  9. Young-Seok Cho
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  10. Myung-Gyu Choi
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Correspondence to Jae Myung Park.

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Oh, H.J., Park, J.M., Yoon, S.B. et al. Bleeding After Endoscopic Procedures in Patients With Chronic Hematologic Thrombocytopenia. Dig Dis Sci 62, 746–754 (2017). https://doi.org/10.1007/s10620-016-4427-4

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  • DOI: https://doi.org/10.1007/s10620-016-4427-4

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