title: Bleeding After Endoscopic Procedures in Patients With Chronic Hematologic Thrombocytopenia.
abstract: Procedure-induced bleeding is a major complication after endoscopic intervention.
  
  
  
  The aim of this study was to investigate the risk of endoscopy-related bleeding in patients with chronic hematologic thrombocytopenia.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 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.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Oh
authors.affiliation: 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. parkjerry@catholic.ac.kr.
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.affiliation: 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.
authors.forename: Seung Bae
authors.initials: SB
authors.lastname: Yoon
authors.affiliation: 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.
authors.forename: Han Hee
authors.initials: HH
authors.lastname: Lee
authors.affiliation: 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.
authors.forename: Chul-Hyun
authors.initials: CH
authors.lastname: Lim
authors.affiliation: 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.
authors.forename: Jin Su
authors.initials: JS
authors.lastname: Kim
authors.affiliation: 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.
authors.forename: Yu Kyung
authors.initials: YK
authors.lastname: Cho
authors.affiliation: 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.
authors.forename: Bo-In
authors.initials: BI
authors.lastname: Lee
authors.affiliation: 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.
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Cho
authors.affiliation: 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.
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Choi
mesh_terms: D000741:Anemia, Aplastic / Q000150:complications*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011696:Purpura, Thrombocytopenic / Q000150:complications*; D012075:Remission, Spontaneous; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology
keywords: Aplastic anemia; Bleeding; Endoscopic procedure; Immune thrombocytopenic purpura; Thrombocytopenia