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Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review

BACKGROUND: Antiangiogenic agents (AAs) are increasingly used to treat malignant tumors and have been associated with gastrointestinal (GI) bleeding and perforation. Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment. Data regarding the safety of endosc...

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Autores principales: Azam, Mohammad, Hudgi, Amit, Uy, Pearl Princess, Makhija, Jinal, Yap, John Erikson L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329849/
https://www.ncbi.nlm.nih.gov/pubmed/36051996
http://dx.doi.org/10.4253/wjge.v14.i7.416
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author Azam, Mohammad
Hudgi, Amit
Uy, Pearl Princess
Makhija, Jinal
Yap, John Erikson L
author_facet Azam, Mohammad
Hudgi, Amit
Uy, Pearl Princess
Makhija, Jinal
Yap, John Erikson L
author_sort Azam, Mohammad
collection PubMed
description BACKGROUND: Antiangiogenic agents (AAs) are increasingly used to treat malignant tumors and have been associated with gastrointestinal (GI) bleeding and perforation. Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment. Data regarding the safety of endoscopy while on antiangiogenic agents is extremely limited. No guidelines are in place to address the concern about withholding these anti-angiogenic drugs. AIM: To evaluate the risks of endoscopy in patients on antiangiogenic agents from 2015 to 2020 at our institution. METHODS: This is a single centered retrospective study approved by the institutional review board statement of the institution. Patients that underwent endoscopy within 28 d of antiangiogenic agents’ treatment were included in the study. Primary outcome of interest was death, and secondary outcomes included perforation and GI bleeding. Data were analyzed utilizing descriptive statistics. Fifty-nine patients were included in the final analysis and a total of eighty-five procedures were performed that were characterized as low risk and high risk. RESULTS: Among the 59 patients a total of 85 endoscopic procedures were performed with 24 (28.2%) categorized as high-risk and 61 (71.8%) procedures as low-risk. Of the total number of patients, (50%) were on bevacizumab and the rest were on imatinib (11.7%), lenvatinib (6.7%) and, ramucirumab (5%). The average duration between administration of AAs and the performance of endoscopic procedures was 9.9 d. No procedure-related adverse events were noted among our study population. We did observe two deaths with one patient, on lenvatinib for metastatic hepatocellular carcinoma, who had persistent bleeding despite esophageal variceal banding and died 4 d later from hemorrhagic shock. Another patient was diagnosed with acute myeloid leukemia died 24 d after an esophagogastroduodenoscopy with biopsy after transition to comfort care. CONCLUSION: As per this single center retrospective study, the rate of endoscopic procedure-related adverse events and death within 28 d of AA administration appears to be low.
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spelling pubmed-93298492022-08-31 Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review Azam, Mohammad Hudgi, Amit Uy, Pearl Princess Makhija, Jinal Yap, John Erikson L World J Gastrointest Endosc Retrospective Study BACKGROUND: Antiangiogenic agents (AAs) are increasingly used to treat malignant tumors and have been associated with gastrointestinal (GI) bleeding and perforation. Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment. Data regarding the safety of endoscopy while on antiangiogenic agents is extremely limited. No guidelines are in place to address the concern about withholding these anti-angiogenic drugs. AIM: To evaluate the risks of endoscopy in patients on antiangiogenic agents from 2015 to 2020 at our institution. METHODS: This is a single centered retrospective study approved by the institutional review board statement of the institution. Patients that underwent endoscopy within 28 d of antiangiogenic agents’ treatment were included in the study. Primary outcome of interest was death, and secondary outcomes included perforation and GI bleeding. Data were analyzed utilizing descriptive statistics. Fifty-nine patients were included in the final analysis and a total of eighty-five procedures were performed that were characterized as low risk and high risk. RESULTS: Among the 59 patients a total of 85 endoscopic procedures were performed with 24 (28.2%) categorized as high-risk and 61 (71.8%) procedures as low-risk. Of the total number of patients, (50%) were on bevacizumab and the rest were on imatinib (11.7%), lenvatinib (6.7%) and, ramucirumab (5%). The average duration between administration of AAs and the performance of endoscopic procedures was 9.9 d. No procedure-related adverse events were noted among our study population. We did observe two deaths with one patient, on lenvatinib for metastatic hepatocellular carcinoma, who had persistent bleeding despite esophageal variceal banding and died 4 d later from hemorrhagic shock. Another patient was diagnosed with acute myeloid leukemia died 24 d after an esophagogastroduodenoscopy with biopsy after transition to comfort care. CONCLUSION: As per this single center retrospective study, the rate of endoscopic procedure-related adverse events and death within 28 d of AA administration appears to be low. Baishideng Publishing Group Inc 2022-07-16 2022-07-16 /pmc/articles/PMC9329849/ /pubmed/36051996 http://dx.doi.org/10.4253/wjge.v14.i7.416 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Azam, Mohammad
Hudgi, Amit
Uy, Pearl Princess
Makhija, Jinal
Yap, John Erikson L
Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review
title Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review
title_full Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review
title_fullStr Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review
title_full_unstemmed Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review
title_short Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review
title_sort safety of endoscopy in patients undergoing treatments with antiangiogenic agents: a 5-year retrospective review
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329849/
https://www.ncbi.nlm.nih.gov/pubmed/36051996
http://dx.doi.org/10.4253/wjge.v14.i7.416
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