Although responsible for only a small proportion of UGIB episodes, tumor-associated bleeding can cause substantial blood loss — often necessitating transfusion — and presents particular treatment challenges.

Most studies of upper gastrointestinal bleeding (UGIB) have focused on peptic ulcers. Tumors are responsible for 1% to 5% of UGIB episodes and present particular treatment challenges. To provide more information on such cases, investigators retrospectively reviewed the records of consecutive patients hospitalized with UGIB at a large urban U.S. hospital between January 2005 and January 2012.

Tumors were the cause of bleeding in 106 (5%) of the 2166 patients; most were located in the stomach. Among the patients with tumors, 73% received transfusions during the index hospitalization. At endoscopy, active bleeding was seen in 30% — oozing in 29%, and spurting in 1%. Discrete ulcers were present in 56%, with adherent clots in 6% and visible vessels in 2%. Endoscopic therapy was performed in 14 of the 32 patients with active bleeding (ethanol or epinephrine injection in 5 patients each; electrocoagulation, argon photocoagulation, epinephrine plus bipolar coagulation, or ethanol plus clip placement in 1 each); hemostasis was successful in 12 (86%). Bleeding resolved without endoscopic therapy in the remaining 18 patients. Fifty patients (49%) were hospitalized for delayed rebleeding at a median of 30 days. Risk factors for such rebleeding were age 60 and hemodynamic instability on presentation.

CITATION(S):

Sheibani S et al. Natural history of acute upper GI bleeding due to tumours: Short-term success and long-term recurrence with or without endoscopic therapy. Aliment Pharmacol Ther 2013 May 28; [e-pub ahead of print].