What are the implications of an upper gastrointestinal (GI) endoscopy in a patient with a history of hepatitis B, who has been on Entecavir (entecavir) therapy for 3 years?

From the Guidelines

Upper GI endoscopy can be safely performed in a patient with a history of hepatitis B who has been on entecavir for 3 years, with standard infection control precautions and no special measures required. The patient's hepatitis B status should be communicated to the endoscopy team, and entecavir should be continued as prescribed, without any need for adjustment or cessation for the procedure 1. The endoscopy can proceed with routine pre-procedure preparations, and post-procedure monitoring should be conducted as usual, with slightly increased attention to potential liver-related complications, although the risk is low in well-controlled hepatitis B 1. Entecavir's effective suppression of viral replication significantly reduces the risk of transmission during the procedure 1.

Key considerations for the procedure include:

• Informing the endoscopy team of the patient's hepatitis B status
• Continuing entecavir as prescribed
• Following standard infection control precautions
• Proceeding with routine pre-procedure preparations
• Monitoring the patient post-procedure for potential liver-related complications

The most recent and highest quality study, published in 2024, provides guidance on best practices for upper endoscopy, including optimization of endoscopic detection of upper GI pathology and post-procedure follow-up evaluation 1. However, the specific management of patients with hepatitis B undergoing upper GI endoscopy is guided by the 2015 update on the management of chronic hepatitis B virus infection, which recommends entecavir as a first-line treatment and emphasizes the importance of suppressing viral replication to prevent disease progression 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Implications of Upper GI Endoscopy in a Patient with Hepatitis B History

• The patient has been on Entecavir therapy for 3 years, which has been shown to be effective in suppressing hepatitis B virus (HBV) DNA levels 2, 3.
• Entecavir has a high barrier to resistance, with a cumulative rate of entecavir-resistant mutations of 1.2% at year 3 2.
• The patient's history of hepatitis B and current Entecavir therapy do not appear to increase the risk of complications from an upper GI endoscopy.
• However, it is essential to note that the patient's liver function and HBV DNA levels should be monitored regularly to ensure that the Entecavir therapy is effective and to minimize the risk of liver damage or other complications 4, 5.
• The use of Entecavir for 3 years has been associated with improvements in liver histology, reduction in the risk of liver failure or hepatocellular carcinoma development, and a favorable safety profile 2, 3.

Considerations for Upper GI Endoscopy

• The patient's medical history, including their hepatitis B status and Entecavir therapy, should be taken into account when planning the upper GI endoscopy.
• The endoscopy procedure should be performed by an experienced gastroenterologist, and the patient should be monitored closely for any signs of complications.
• The patient's liver function and HBV DNA levels should be monitored regularly after the procedure to ensure that the Entecavir therapy is still effective and to minimize the risk of liver damage or other complications 4, 5.

Entecavir Therapy and HBV DNA Suppression

• Entecavir has been shown to be effective in suppressing HBV DNA levels, with a greater than 90% chance of undetectable HBV DNA during continuous therapy 2, 3.
• The patient's HBV DNA levels should be monitored regularly to ensure that the Entecavir therapy is effective and to minimize the risk of liver damage or other complications.
• Alternative therapies, such as combination therapy with tenofovir, may be considered for patients who do not achieve complete viral suppression with Entecavir monotherapy 5.