Introduction: Neutropenic patients are at high risk for infectious complications, and endoscopic procedures carry a risk of infections which may be increased in these patients. Many of these patients have concomitant thrombocytopenia and are at higher risk of bleeding, and gastroenterologists are frequently consulted to consider endoscopic evaluation in these patients. Current evidence regarding the safety of endoscopic procedures in neutropenic patients is limited, and guidelines are unclear, with some suggesting use of periprocedural antibiotics in such high-risk patients. We performed a systematic review and meta-analysis to evaluate the safety of endoscopic procedures in neutropenic patients.
Methods: Systematic literature search was performed until June 2022 at Medline, Embase, Web of Science, and Cochrane library database to identify all studies that evaluated the safety of endoscopic procedures in neutropenic patients. Our primary outcome was to evaluate the rate of infectious complications, and the secondary outcome was to evaluate the rate of bacteremia. All analysis was conducted utilizing Comprehensive meta-analysis software.
Results: Four observational studies were included in the final analysis. There were 1392 procedures performed on neutropenic patients. Neutropenia was defined as < 500 cells/ul in one study, < 1000 cell/ul in two studies and less than 1500 in one study. Periprocedural antibiotics were given to approximately 70% of the patients. Pooled rate of infectious complications were 10.6% (95% CI: 2.8%-33%), I2=97.63%. In a subgroup analysis including patients with blood cultures done post-procedure, the risk of the pooled rate of bacteremia was 9.5% (5.5%-16.1%), I2=34.39%.
Discussion: Our study revealed that the risk of infectious events and bacteremia is high in neutropenic patients. However, given the lack of a control group in most studies, it is hard to conclude if a higher risk of infectious complications is secondary to neutropenia or endoscopic procedures. Therefore, larger prospective comparative studies are needed to compare infectious outcomes of neutropenic patients who underwent endoscopic procedures and those who do not require any invasive procedures. Endoscopic procedures should be performed with caution in neutropenic patients with valid indications, and periprocedural antibiotics should be considered to decrease the risk.
