Safety and Outcome of Diagnostic and Endoscopic Procedure for Portal Hypertension in Patients with Portal Hypertension Associated with Severe Thrombocytopenia or Anemia: A Retrospective Observational Study

Abstract Appropriate lower threshold of hemoglobin or platelet counts to effectively perform endoscopic procedure in patients with portal hypertension has not been well studied. The objective of the study was to determine the safety and efficacy of endoscopic procedure in portal hypertensive patients with severe anemia or thrombocytopenia. This study was a retrospective analysis of consecutive portal hypertension patients, who underwent upper gastrointestinal endoscopy. Follow-up period was 1 month after endoscopy. After collecting clinical, biochemical, and endoscopic data, patients were divided into two groups. Group A (n = 58, platelet counts < 50 × 109 cells/L or hemoglobin level < 7 g/dL) and Group B (n = 43, platelet counts ≥ 50 (×109 cells/L and hemoglobin ≥ 7 g/dL). Immediate complication, hospital stays, rebleeding, rehospitalization, and mortality were compared in both groups. Comparisons of quantitative data between the two groups were done using independent sample t-test or Mann–Whitney U test. Qualitative data were expressed as percentage and analyzed using Kruskal–Wallis test. Multivariate analysis was used to determine the independent predictors of rehospitalization and death. p-Value of less than 0.05 was taken as significant. Immediate complication (1.7: 2.3%, p = 0.95), rebleeding (6.9%: 2.3%, p = 0.41), and death rate (3.4:6.9%, p = 0.65) were similar in group A and B. Rehospitalization rate (17.2:9.3%, p < 0.001) and hospital stay (5.87 ± 1.86 vs. 4.97 ± 1.92 days, p = 0.02), respectively, were significantly higher in group A than B, but these were more attributable to severity of liver disease rather than low platelets or hemoglobin level. Diagnostic and therapeutic endoscopic procedure was safe and effective in severely low anemic thrombocytopenic patients. Prolonged hospital stay and higher rehospitalization were more attributable to the severity of liver disease rather than severe anemia or thrombocytopenia.