Mohammad U. Azam, MD1, Pearl Princess Uy, MD1, Amit Hudgi, MBBS1, Mohammad Maysara Asfari, MD1, Eula P. Tetangco, MD, MPH2, John Erikson L. Yap, MD2; 1Medical College of Georgia, Augusta, GA; 2Medical College of Georgia at Augusta University, Augusta, GA
Introduction: Antiangiogenic agents (AAs) have been increasingly used for the treatment of malignant tumors but are reported to be associated with a higher risk of gastrointestinal (GI) bleeding and perforation. Elective surgery is usually delayed 28 days after AAs treatment. Data is limited regarding the safety of endoscopy while on AAs. The primary aim of this study is to determine the procedure-related adverse effects (AE) and death among patients who had endoscopic procedures while on AAs. Methods: Patients who underwent an endoscopic procedure from January 1, 2015 – March 31, 2020 and received AAs including vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor (VEGFR) inhibitors, epidermal growth factor receptor (EGFR) inhibitors, multi-targeted tyrosine kinase inhibitors, and mammalian target of rapamycin (mTOR) inhibitor within 28 days were included. Data collected included demographic information, type of malignancy, type and timing of AA used, procedure-related AE and death within 30 days of endoscopy. Endoscopic procedures were also categorized into high and low-risk based on risk of perforation and GI bleeding. Data were analyzed with descriptive statistics. This study was approved by the Institutional Review Board for Augusta University. Results: 66 patients (male/female= 26/40) with a mean age of 65 years underwent a total of 85 endoscopic procedures within 28 days of treatment with AAs. 53% (35/66) had metastatic disease and most common primary sites include colorectal (22.7%), ovarian (13.6%), and liver (12.1%). Of the 85 endoscopic procedures performed, 22 (25.9%) were considered high-risk which include variceal banding, percutaneous gastrostomy tube placement, pneumatic balloon dilation, and stent placement, whereas 63 (74.1%) were low-risk. The average duration from administration of AAs to endoscopy was 9.8 days. There were no procedure-related adverse effects, but a patient on Lenvatinib for metastatic hepatocellular carcinoma had persistent bleeding despite esophageal variceal banding and died 4 days later from hemorrhagic shock. Discussion: In this single center retrospective study, the rate of procedure-related AE and death within 30 days of endoscopy on AAs appear to be low. This is consistent with a published data by Kachaamy et al. As gastroenterologist, understanding endoscopic-related and medication adverse effects are crucial for optimal patient care. Future prospective studies are needed to confirm these findings.
Table 1: Baseline Characteristics of the Study Population
Table 2: List of Antiangiogenic Agents
Disclosures: Mohammad Azam indicated no relevant financial relationships. Pearl Princess Uy indicated no relevant financial relationships. Amit Hudgi indicated no relevant financial relationships. Mohammad Maysara Asfari indicated no relevant financial relationships. Eula Tetangco indicated no relevant financial relationships. John Erikson Yap indicated no relevant financial relationships.