415 Evaluating Safety of Gastrointestinal (GI) Endoscopy, Mucosal Biopsy and Polypectomy in Patients With Thrombocytopenia

415 Evaluating Safety of Gastrointestinal (GI) Endoscopy, Mucosal Biopsy and Polypectomy in Patients With Thrombocytopenia Somashekar G. Krishna*, Bhavana Bhagya Rao, Jeffrey H. Lee, Srinivas Ramireddy, William a. Ross Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Medical Center, Columbus, OH; Department of Gastroenterology, Hepatology and Nutrition, University of Texas at MD Anderson Cancer Center, Houston, TX; Gastroenterology, Hepatology and Nutrition, University of Texas-Houston medical school, Houston, TX; General Internal medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL Background: Patients with thrombocytopenia are assumed to be at higher risk for spontaneous or procedure related GI bleeding. The safety of performing endoscopy in this patient group has not been determined in large studies. Objective: To determine the safety of GI endoscopy, standard forceps biopsy and polypectomy in cancer patients with thrombocytopenia. Methods: Retrospective review of endoscopic procedures performed in adult patients with pre-procedure platelet (plt) count (#) 75,000/ L between 1/1/2008 and 6/30/2012 at a tertiary cancer center. Results: A total of 617 endoscopic procedures (351 EGDs, 90 colonoscopies and 176 sigmoidoscopies), performed in 395 patients (225 male, mean age 54.8 15.8 years) were reviewed. The primary diagnosis included 332 cases (84.1%) of hematological malignancies. The most common indications were suspected GI graft versus host disease (GVHD, 47.3%) and symptoms suggestive of GI bleeding (37.1%). Platelets were transfused prior ( 24 hours) in 424 (68.7% of 617) endoscopies; with their pre-transfusional plt # found to be lower than those who received no transfusion. (24,950/ L vs. 37,250/ L, p 0.001). Standard forceps biopsies (bxs) were obtained in 398 (64.5% of 617) procedures with mean plt # of 40,568 1,204/ L (table 1). Bleeding due to bx was seen in 8 (2%). Bleeding was immediate in 7 and required intervention in 5 cases (hemoclips-4, epinephrine injection-1; table 2). Delayed bleeding from the bx site occurred in 1 case and was managed by hemoclip. Follow up of patients who were biopsied (including those with bx related bleed) for 3 days showed no significant increase in blood or plt requirements. Among 398 endoscopies with biopsies, 44.7% had significant pathology, with definitive GI-GVHD being the most common diagnosis (66% of 329 endoscopies done to evaluate for GVHD). A total of 45 polyps were removed in 17 colonoscopies with mean plt # of 42,882 8,971/ L (table 1). Immediate bleeding at polypectomy site was seen in 2 patients following hot snare and cold forceps polypectomies (table 2), with risk of bleeding being 4%. Mean hemoglobin prior to procedure (9.67 g/dL) did not significantly decrease following polypectomy (9.16 g/dL) and blood transfusion requirements did not increase. Variceal banding (n 5), colon decompression tube (n 4), and percutaneous gastrostomy tube placement (n 8) were performed with a mean plt # of 38,800/ L, 43,750/ L and 48,200/ L respectively, without any bleeding or other complications. Conclusion: This study represents the largest endoscopic experience reported in thrombocytopenic patients. The incidence of standard forceps bx and polypectomy related bleeding was elevated but bleeding was typically minor and easily controlled. Thus thrombocytopenia should not be a deterrent to endoscopic biopsies nor should it rule out other interventions such as polypectomy.