Endoscopy After Bevacizumab Appears Safe: GIE | July 2026

Introduction:

Bevacizumab is widely used in metastatic colorectal cancer (mCRC) because of its survival benefits but is associated with impaired wound healing, gastrointestinal perforation, and bleeding. These concerns often lead clinicians to delay endoscopic procedures after bevacizumab therapy, despite limited evidence supporting this practice.

Why was this study needed?:

The optimal timing of endoscopy after recent bevacizumab exposure remains uncertain.

Clinicians are concerned about increased risks of gastrointestinal perforation and postprocedural bleeding.

Existing evidence is limited and largely based on small observational studies.

Better data are needed to guide the safety of diagnostic and therapeutic endoscopic procedures in patients receiving bevacizumab.

Results:

In this large propensity score–matched analysis, recent bevacizumab use was not associated with an increased risk of gastrointestinal perforation within 30 days after either diagnostic or therapeutic endoscopy compared with other active chemotherapy. However, patients receiving bevacizumab had a significantly higher risk of postprocedural bleeding, particularly after therapeutic endoscopic interventions, with the excess risk largely driven by upper gastrointestinal procedures. Diagnostic endoscopy alone did not demonstrate an increased bleeding risk.

Clinical Impact:

These findings suggest that recent bevacizumab therapy should not automatically delay necessary endoscopic evaluation because the feared increase in perforation risk was not observed. However, therapeutic endoscopic procedures, especially upper GI interventions, should be undertaken with greater caution, balancing procedural benefits against the elevated bleeding risk. Careful procedural planning and post-procedure monitoring remain essential.

Bottom Line:

Recent bevacizumab exposure does not increase post-endoscopy perforation risk but is associated with higher bleeding risk after therapeutic endoscopic procedures, supporting individualized procedural planning rather than routine postponement of endoscopy.