From the Guidelines
Patients with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency can undergo Upper Gastrointestinal (GI) Tract Endoscopy with or without biopsy, as the procedure itself does not pose specific risks related to this condition. The key to safe management is awareness of the patient's G6PD status by the gastroenterologist to avoid using medications that might trigger hemolysis 1.
Pre-procedure Considerations
When considering an upper GI tract endoscopy for a patient with G6PD deficiency, several factors should be taken into account:
- The patient's understanding of the proposed test and completion of a consent form are crucial, as emphasized in the quality standards for upper gastrointestinal endoscopy 1.
- Significant comorbidities and the patient's current medications should be reviewed to ensure no potential interactions that could exacerbate their condition.
- The choice of sedatives and analgesics should be carefully considered, although commonly used sedatives like midazolam, fentanyl, and propofol are not known to trigger hemolytic reactions in G6PD-deficient patients.
Procedure and Biopsy
The procedure for upper GI tract endoscopy, including biopsy if necessary, does not inherently pose risks for patients with G6PD deficiency.
- The quality indicators for upper GI endoscopy, such as photo documentation of relevant anatomical landmarks and detected lesions, adequate mucosal visualization, and the use of mucosal cleansing techniques, should be followed as outlined in the position statement by the British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland 1.
- Biopsy, if required for diagnostic purposes, can be performed safely, as G6PD deficiency does not affect the healing process after tissue sampling.
Post-procedure Care
After the procedure, it is essential to:
- Record details such as the number of histological samples taken, correct labeling of samples, dose of sedation and/or analgesia given, specific post-procedure advice, and follow-up arrangements, as recommended in the guidelines 1.
- Ensure the patient is aware of any necessary post-procedure care and precautions to minimize risks associated with their G6PD deficiency.
By following these guidelines and considering the patient's G6PD status, upper GI tract endoscopy with or without biopsy can be safely performed, prioritizing the patient's morbidity, mortality, and quality of life outcomes.
From the Research
G6PD Deficiency and Upper GI Tract Endoscopy
- There is no direct evidence in the provided studies that specifically addresses whether a patient with Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency should undergo Upper Gastrointestinal (GI) Tract Endoscopy with or without biopsy.
- However, the studies provide information on the management of G6PD deficiency and the medications that are safe to use in patients with this condition 2, 3, 4.
- It is recommended that patients with G6PD deficiency avoid exposure to oxidative stressors, including certain medications and infections, to prevent hemolysis 2, 3, 5.
- The studies also highlight the importance of screening for G6PD deficiency, informing patients of the risks and signs of hemolytic crisis, and being able to identify laboratory and clinical signs of hemolysis 2, 5.
Medications and G6PD Deficiency
- Certain medications, such as dapsone, methylthioninium chloride, nitrofurantoin, phenazopyridine, primaquine, rasburicase, and tolonium chloride, should be avoided in patients with G6PD deficiency due to the risk of hemolysis 3.
- However, other medications, such as benzodiazepines, codeine, propofol, fentanyl, and ketamine, have been found to be safe to use in patients with G6PD deficiency 2, 3.
- A real-world study found that many medications suspected to carry risks for hemolysis in G6PD-deficient patients have been prescribed safely to these patients, providing reassurance to patients, prescribers, and regulators 4.
Management of G6PD Deficiency
- The management of G6PD deficiency involves preventing hemolysis by avoiding oxidative stressors and using safe medications 2, 3, 5.
- Patients with G6PD deficiency should be informed of the risks and signs of hemolytic crisis, and clinicians should be able to identify laboratory and clinical signs of hemolysis 2, 5.
- Acute hemolytic anemia can be managed effectively if promptly diagnosed, and reliable diagnostic procedures are available 5.