Natural history of acute upper GI bleeding due to tumours: Short-term success and long-term recurrence with or without endoscopic therapy

S. Sheibani, J. J. Kim, B. Chen, S. Park, B. Saberi, Kian Keyashian, J. Buxbaum, L. Laine

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours. Aim To determine the presentation, endoscopic findings, treatment and outcomes in patients with UGIB from malignant tumours and identify risk factors associated with rebleeding. Methods Consecutive patients who were hospitalised with haematemesis, melena or haematochezia and underwent upper endoscopy were identified retrospectively by reviewing an endoscopy database. Patients with UGIB due to biopsy-proven malignant tumours were studied. Results Tumours were the source of bleeding in 106 (5%) of 2,166 patients with UGIB. Tumours were oesophageal in 17 (16%), gastric in 77 (73%) and duodenal in 12 (11%). At presentation, 84 (79%) did not have known cancer previously, and 79 (75%) had metastatic disease. Seventy-seven (73%) received transfusions at index hospitalisation. At endoscopy, 32 (30%) had active bleeding (31 oozing, 1 spurting). Among actively bleeding patients, haemostasis was achieved in 12 (86%) of 14 receiving endoscopic therapy and all 18 not receiving endoscopic treatment. Hospitalisation for rebleeding occurred in 50 (49%) of 103 at a median of 30 days (3-885). On multivariate analysis, age ≤60 years (OR = 2.49, 95% CI 1.06-5.81) and haemodynamic instability (OR = 2.42, 95% CI 1.08-5.46) were associated with rebleeding. Conclusions Patients presenting with tumour-associated UGIB have substantial blood loss, with three-quarters requiring transfusion at presentation. Initial haemostasis occurs in almost all patients, with or without endoscopic therapy, but rebleeding requiring repeat hospitalisation occurs in approximately half the patients and is more common in patients who are ≤60 years of age and have haemodynamic instability at presentation.

Original languageEnglish (US)
Pages (from-to)144-150
Number of pages7
JournalAlimentary Pharmacology and Therapeutics
Volume38
Issue number2
DOIs
StatePublished - Jul 2013
Externally publishedYes

Fingerprint

Natural History
Hemorrhage
Recurrence
Neoplasms
Endoscopy
Therapeutics
Hospitalization
Hemostasis
Hemodynamics
Melena
Hematemesis
Gastrointestinal Hemorrhage
Stomach
Multivariate Analysis
Databases
Biopsy

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Medicine(all)

Cite this

Natural history of acute upper GI bleeding due to tumours : Short-term success and long-term recurrence with or without endoscopic therapy. / Sheibani, S.; Kim, J. J.; Chen, B.; Park, S.; Saberi, B.; Keyashian, Kian; Buxbaum, J.; Laine, L.

In: Alimentary Pharmacology and Therapeutics, Vol. 38, No. 2, 07.2013, p. 144-150.

Research output: Contribution to journalArticle

Sheibani, S. ; Kim, J. J. ; Chen, B. ; Park, S. ; Saberi, B. ; Keyashian, Kian ; Buxbaum, J. ; Laine, L. / Natural history of acute upper GI bleeding due to tumours : Short-term success and long-term recurrence with or without endoscopic therapy. In: Alimentary Pharmacology and Therapeutics. 2013 ; Vol. 38, No. 2. pp. 144-150.
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abstract = "Background Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours. Aim To determine the presentation, endoscopic findings, treatment and outcomes in patients with UGIB from malignant tumours and identify risk factors associated with rebleeding. Methods Consecutive patients who were hospitalised with haematemesis, melena or haematochezia and underwent upper endoscopy were identified retrospectively by reviewing an endoscopy database. Patients with UGIB due to biopsy-proven malignant tumours were studied. Results Tumours were the source of bleeding in 106 (5{\%}) of 2,166 patients with UGIB. Tumours were oesophageal in 17 (16{\%}), gastric in 77 (73{\%}) and duodenal in 12 (11{\%}). At presentation, 84 (79{\%}) did not have known cancer previously, and 79 (75{\%}) had metastatic disease. Seventy-seven (73{\%}) received transfusions at index hospitalisation. At endoscopy, 32 (30{\%}) had active bleeding (31 oozing, 1 spurting). Among actively bleeding patients, haemostasis was achieved in 12 (86{\%}) of 14 receiving endoscopic therapy and all 18 not receiving endoscopic treatment. Hospitalisation for rebleeding occurred in 50 (49{\%}) of 103 at a median of 30 days (3-885). On multivariate analysis, age ≤60 years (OR = 2.49, 95{\%} CI 1.06-5.81) and haemodynamic instability (OR = 2.42, 95{\%} CI 1.08-5.46) were associated with rebleeding. Conclusions Patients presenting with tumour-associated UGIB have substantial blood loss, with three-quarters requiring transfusion at presentation. Initial haemostasis occurs in almost all patients, with or without endoscopic therapy, but rebleeding requiring repeat hospitalisation occurs in approximately half the patients and is more common in patients who are ≤60 years of age and have haemodynamic instability at presentation.",
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N2 - Background Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours. Aim To determine the presentation, endoscopic findings, treatment and outcomes in patients with UGIB from malignant tumours and identify risk factors associated with rebleeding. Methods Consecutive patients who were hospitalised with haematemesis, melena or haematochezia and underwent upper endoscopy were identified retrospectively by reviewing an endoscopy database. Patients with UGIB due to biopsy-proven malignant tumours were studied. Results Tumours were the source of bleeding in 106 (5%) of 2,166 patients with UGIB. Tumours were oesophageal in 17 (16%), gastric in 77 (73%) and duodenal in 12 (11%). At presentation, 84 (79%) did not have known cancer previously, and 79 (75%) had metastatic disease. Seventy-seven (73%) received transfusions at index hospitalisation. At endoscopy, 32 (30%) had active bleeding (31 oozing, 1 spurting). Among actively bleeding patients, haemostasis was achieved in 12 (86%) of 14 receiving endoscopic therapy and all 18 not receiving endoscopic treatment. Hospitalisation for rebleeding occurred in 50 (49%) of 103 at a median of 30 days (3-885). On multivariate analysis, age ≤60 years (OR = 2.49, 95% CI 1.06-5.81) and haemodynamic instability (OR = 2.42, 95% CI 1.08-5.46) were associated with rebleeding. Conclusions Patients presenting with tumour-associated UGIB have substantial blood loss, with three-quarters requiring transfusion at presentation. Initial haemostasis occurs in almost all patients, with or without endoscopic therapy, but rebleeding requiring repeat hospitalisation occurs in approximately half the patients and is more common in patients who are ≤60 years of age and have haemodynamic instability at presentation.

AB - Background Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours. Aim To determine the presentation, endoscopic findings, treatment and outcomes in patients with UGIB from malignant tumours and identify risk factors associated with rebleeding. Methods Consecutive patients who were hospitalised with haematemesis, melena or haematochezia and underwent upper endoscopy were identified retrospectively by reviewing an endoscopy database. Patients with UGIB due to biopsy-proven malignant tumours were studied. Results Tumours were the source of bleeding in 106 (5%) of 2,166 patients with UGIB. Tumours were oesophageal in 17 (16%), gastric in 77 (73%) and duodenal in 12 (11%). At presentation, 84 (79%) did not have known cancer previously, and 79 (75%) had metastatic disease. Seventy-seven (73%) received transfusions at index hospitalisation. At endoscopy, 32 (30%) had active bleeding (31 oozing, 1 spurting). Among actively bleeding patients, haemostasis was achieved in 12 (86%) of 14 receiving endoscopic therapy and all 18 not receiving endoscopic treatment. Hospitalisation for rebleeding occurred in 50 (49%) of 103 at a median of 30 days (3-885). On multivariate analysis, age ≤60 years (OR = 2.49, 95% CI 1.06-5.81) and haemodynamic instability (OR = 2.42, 95% CI 1.08-5.46) were associated with rebleeding. Conclusions Patients presenting with tumour-associated UGIB have substantial blood loss, with three-quarters requiring transfusion at presentation. Initial haemostasis occurs in almost all patients, with or without endoscopic therapy, but rebleeding requiring repeat hospitalisation occurs in approximately half the patients and is more common in patients who are ≤60 years of age and have haemodynamic instability at presentation.

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