Background and Aims

Gastrointestinal bleeding (GIB) in the setting of thrombocytopenia raises concerns about endoscopic procedure risk. We aimed to assess the safety and outcomes of endoscopy for overt GIB in the setting of severe thrombocytopenia in liver cirrhosis (LC) and non-liver cirrhosis (NLC).

Methods

This is a retrospective study on inpatients who underwent endoscopy within 24 hours of presentation for overt GIB with a platelet count (PC) of 20 to <50 × 10³/mL. Outcomes included diagnostic and therapeutic yields, procedural adverse events, packed red blood cell (pRBC) and platelet transfusions, recurrent bleeding rate, and all-cause and GIB-related mortality.

Results

One hundred forty-four patients were identified. The median PC was 41 × 10³/mL and 61% had LC. The diagnostic yield was 68% (LC = 61%, NLC = 79%, P = .04). Therapeutic yield was 60% (59% vs 60%, P = 1.00). The initial hemostasis rate was 94% with one adverse event. The median number of pRBC and platelet transfusions decreased after intervention in the entire cohort. Recurrent bleeding rates were 22% at 1 month and 30% at 1 year, with no differences between groups. An increased international normalized ratio (INR) >2 was a predictor of recurrent bleeding. All-cause mortality was 19% at 1 month and 37% at 1 year, whereas GIB-associated mortality in our cohort was only 3% at 1 month and 4% at 1 year, with no significant difference between LC and NLC. Predictors of mortality were INR >2, activated partial thromboplastin time >38 seconds, hypotension, intensive care unit admission, and pulmonary comorbidities.

Conclusion

In this study cohort, we observed that endoscopy for overt GIB in the setting of severe thrombocytopenia in patients with LC and NLC appears safe, has moderate diagnostic and therapeutic yields with high initial hemostasis rate, and is associated with a significant decrease in pRBC and platelet transfusions. Recurrent bleeding and all-cause mortality rates remain high.

中文翻译：

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内镜干预治疗严重血小板减少症明显胃肠道出血的结果

背景和目标

血小板减少症患者的胃肠道出血（GIB）引起了人们对内镜手术风险的担忧。我们的目的是评估在肝硬化（LC）和非肝硬化（NLC）中严重血小板减少的情况下公开GIB的内镜检查的安全性和结果。

方法

这是一项对住院患者的回顾性研究，该患者在就诊的24小时内因血小板计数（PC）为20至<50×10 ³ / mL的明显GIB而接受内镜检查。结果包括诊断和治疗的获益率，程序性不良事件，充盈的红细胞（pRBC）和血小板输注，复发性出血率以及全因和GIB相关的死亡率。

结果

确定了144名患者。中位PC为41×10 ³ / mL，61％为LC。诊断产率为68％（LC = 61％，NLC = 79％，P  = .04）。治疗产率为60％（59％对60％，P = 1.00）。最初的止血率为94％，其中有一个不良事件。在整个队列中进行干预后，pRBC和血小板输注的中位数减少。复发出血率在1个月时为22％，在1年时为30％，两组之间无差异。国际标准化比率（INR）> 2的增加是复发性出血的预测指标。全因死亡率在1个月时为19％，在1年时为37％，而我们队列中与GIB相关的死亡率在1个月时仅为3％，在1年时为4％，LC和NLC之间无显着差异。死亡率的预测指标是INR> 2，活化的部分凝血活酶时间> 38秒，低血压，重症监护病房入院和肺部合并症。

结论

在本研究队列中，我们观察到在患有LC和NLC的严重血小板减少症患者中，明显的GIB的内窥镜检查看来是安全的，具有中等的诊断和治疗效果，且初始止血率较高，并且与pRBC和血小板的显着降低有关输血。复发性出血和全因死亡率仍然很高。