J Gastric Cancer.  2017 Dec;17(4):374-383. 10.5230/jgc.2017.17.e42.

Clinical Outcomes of Endoscopic Hemostasis for Bleeding in Patients with Unresectable Advanced Gastric Cancer

• Song IJ
• Kim HJ
• Lee JA
• Park JC
• Shin SK
• Lee SK
• Lee YC
• Chung H

• KMID: 2398803
• DOI: http://doi.org/10.5230/jgc.2017.17.e42

Abstract

PURPOSE
Bleeding is one of the most serious complications of advanced gastric cancer (AGC) and is associated with a poor prognosis. This study aimed to evaluate the clinical outcomes of endoscopic hemostasis for bleeding in patients with unresectable AGC.
MATERIALS AND METHODS
This study included 106 patients with bleeding associated with gastric cancer who had undergone endoscopic hemostasis between January 2010 and December 2013. Clinical characteristics, treatment outcomes, including rates of successful endoscopic hemostasis and rebleeding, risk factors for rebleeding, and overall survival (OS) were investigated.
RESULTS
Successful initial hemostasis was achieved in 83% of patients. Rebleeding occurred in 28.3% of patients within 30 days. The median OS after initial hemostasis was lower in patients with rebleeding than in those without rebleeding (2.7 and 3.9 months, respectively, P=0.02). There were no significant differences in disease status and rebleeding rates among patients with partial response or stable disease (n=4), progressive disease (n=64), and first diagnosis of disease (n=38). Univariate and multivariate analyses (P=0.038 and 0.034, respectively) revealed that transfusion of ≥5 units of RBCs was a significant risk factor for rebleeding.
CONCLUSIONS
Despite favorable success rates of endoscopic hemostasis for bleeding associated with gastric cancer, the 30-day rebleeding rate was 28.3% and the median OS was significantly lower in patients with rebleeding than in those without rebleeding. Massive transfusion (≥5 units of RBCs) was the only significant risk factor for rebleeding. Patients with bleeding associated with AGC who have undergone massive transfusion should be observed closely following endoscopic hemostasis. Further research on approaches to reduce rebleeding rate and prevent death is needed.

Keyword

Endoscopic hemostasis; Hemorrhage; Stomach neoplasms

MeSH Terms

Diagnosis
Hemorrhage*
Hemostasis
Hemostasis, Endoscopic*
Humans
Multivariate Analysis
Prognosis
Risk Factors
Stomach Neoplasms*

Figure

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  Fig. 1 Study flow diagram. EGD = esophagogastroduodenoscopy; APC = argon plasma coagulation.

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  Fig. 2 Kaplan-Meier curves of OS according to the occurrence of rebleeding. In this model, OS after initial hemostasis was lower in patients with rebleeding than in those without rebleeding (median months [interquartile range], 2.7 [1–5.7] and 3.9 [0.9–7.8], respectively; P=0.020). OS = overall survival.

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