Endoscopy for the diagnosis and treatment of gastrointestinal bleeding caused by malignancy.

Autor: Abu-Sbeih H; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Department of Internal Medicine, The University of Missouri, Kansas City, Missouri, USA., Szafron D; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA., Elkafrawy AA; Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA., Garcia-Rodriguez V; Department of Internal Medicine, The University of Texas Health Science Center, Houston, Texas, USA., Ma W; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Xu A; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA., Khurana S; Department of Internal Medicine, The University of Texas Health Science Center, Houston, Texas, USA., Numan L; Department of Internal Medicine, The University of Missouri, Kansas City, Missouri, USA., Chen E; Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA., Goldstein R; Department of Internal Medicine, The University of Texas Health Science Center, Houston, Texas, USA., Tsen A; Department of Internal Medicine, The University of Texas Health Science Center, Houston, Texas, USA., Peng Y; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Department of Bioscience, Rice University, Houston, Texas, USA., Blum M; Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Kopetz ES; Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Ikoma N; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Shatila M; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Qiao W; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Raju GS; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Ross WA; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Ge PS; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Coronel E; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Wang Y; Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jazyk: angličtina
Zdroj: Journal of gastroenterology and hepatology [J Gastroenterol Hepatol] 2022 Oct; Vol. 37 (10), pp. 1983-1990. Date of Electronic Publication: 2022 Jun 30.
DOI: 10.1111/jgh.15922
Abstrakt: Background and Aim: The diagnosis and treatment of gastrointestinal (GI) bleeding secondary to malignancy can be challenging. Endoscopy is the gold standard to diagnose and treat gastrointestinal bleeding but clinical characteristics and outcomes of patients with malignancy-related bleeding are not well understood. This study aims to look at clinical characteristics, endoscopic findings, safety and clinical outcomes of endoscopic interventions for GI malignancy-related bleeding.
Methods: We retrospectively reviewed outcomes of patients with confirmed GI malignancies who underwent endoscopy for GI bleeding at MD Anderson Cancer Center between 2010 and 2019. Cox hazard analysis was conducted to identify factors associated with survival.
Results: A total of 313 patients were included, with median age of 59 years; 74.8% were male. The stomach (30.0%) was the most common tumor location. Active bleeding was evident endoscopically in 47.3% of patients. Most patients (77.3%) did not receive endoscopic treatment. Of the patients who received endoscopic treatment, 57.7% had hemostasis. No endoscopy-related adverse events were recorded. Endoscopic treatment was associated with hemostasis (P < 0.001), but not decreased recurrent bleeding or mortality. Absence of active bleeding on endoscopy, stable hemodynamic status at presentation, lower cancer stage, and surgical intervention were associated with improved survival.
Conclusions: This study indicates that endoscopy is a safe diagnostic tool in this patient population; while endoscopic treatments may help achieve hemostasis, it may not decrease the risk of recurrent bleeding or improve survival.
(© 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
Databáze: MEDLINE
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