Endoscopic polypectomy in a cirrhotic patient with significant thrombocytopenia after administration of avatrombopag

Cirrhotic patients are often excluded from invasive endoscopic procedures or receive inadequate medical care due to fear of potential bleeding complications. Thrombopoietin receptor agonists have been shown to transiently elevate platelet count in these patients and, therefore, potentially reduce the risk of bleeding complications.

A 44-year-old man with metabolic dysfunction-related liver cirrhosis and thrombocytopenia (platelets<30 K/μL) underwent a colonoscopy as part of a pre-transplant screening. A 2.5 cm diameter polyp (Paris Is) was detected in the presence of portal colopathy, with histological findings compatible with dysplastic adenoma. The patient received a thrombopoietin receptor agonist (avatrombopag). After treatment with avotrombopag for five days, he showed an elevation in platelet count (77 K/μL) on day 8. On day 9, endoscopic polypectomy was performed with endoscopic mucosal resection after injection with adrenaline solution followed by suturing of the mucosal defect with metal clips. The patient did not experience any immediate or late complications (bleeding, perforation). Histological findings reported infiltrative adenocarcinoma of the colon, with the presence of neoplastic cells of moderate to good differentiation adjacent to the endoscopic resection margin. The patient subsequently underwent surgical resection of the adenocarcinoma after receiving a second avatrombopag course, without bleeding complications.

The use of avatrombopag allows safe endoscopic polypectomy of large colonic polyps in cirrhotic patients with significant thrombocytopenia.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025