Clinical impact of endoscopy in severely thrombocytopenic patients with hematologic malignancy experiencing gastrointestinal bleeding.

Background: Gastrointestinal bleeding (GIB) is a major cause of hospitalization worldwide. Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction. There is no consensus on the optimal platelet level that would be safe for endoscopic intervention, although a platelet level of > 50 × 10⁹ / L was suggested based on expert opinion. There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.

Aim: To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.

Methods: This is a single center retrospective study. The data was collected from the electronic health record from 2018 to 2020. Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count ≤ 50 × 10⁹/L were included in the study. Outcomes included mortality, transfusion requirements, length of stay, intensive care unit admission and recurrent bleeding. A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy > 24 hours.

Results: A total of 76 patients were identified. The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm. There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day (P = 0.13) or 1 year (P = 0.78) mortality, recurrent bleeding (P = 0.68), transfusion of red blood cells (P = 0.47), platelets (P = 0.31), or length of stay (P = 0.94). A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality (P = 0.11 and 0.46, respectively) compared to routine endoscopy, but was associated with decreased recurrent bleeding in 30 days (P = 0.01).

Conclusion: Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.