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Can Endoscopic Bleeding Control Improve the Prognosis of Advanced Gastric Cancer Patients?: A Retrospective
Hyungchul Park1, Ji Yong Ahn, Hwoon-Yong Jung
1Departments of *Internal Medicine †Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Gastric bleeding in cancer patients impacts survival. Successful endoscopic bleeding control is crucial for improving prognosis, though rebleeding can occur. This study highlights the importance of effective hemostasis.
Area of Science:
- Gastroenterology
- Oncology
- Endoscopic Surgery
Background:
- Gastric bleeding is a frequent complication in gastric cancer patients, posing treatment challenges.
- The impact of gastric bleeding on survival and the efficacy of bleeding control require further investigation.
Purpose of the Study:
- To determine if gastric bleeding affects survival in gastric cancer patients.
- To assess if successful bleeding control improves prognosis in these patients.
Main Methods:
- Retrospective review of 64 gastric cancer patients with bleeding undergoing endoscopic therapy (bleeding group).
- Matched 1:2 with 128 gastric cancer patients without bleeding (control group) by age, sex, and cancer stage.
- Analysis of survival, bleeding treatment methods, hemostasis success, and rebleeding rates.
Main Results:
- Initial hemostasis rate was 73.4%, with coagrasper being the most common treatment.
- Successful bleeding control was achieved in 47 patients, with a 36.2% rebleeding rate within 3 days.
- Median survival was significantly longer in the control group (18.5 mo) versus the bleeding group (6.5 mo), and in successful (8.5 mo) versus failed bleeding control groups (1.8 mo).
Conclusions:
- Successful bleeding control is a critical factor for improving survival in gastric cancer patients experiencing bleeding.
- Risk factors for bleeding include specific tumor types (Borrmann II, IV) and use of antiplatelet/anticoagulant medications.
Background:
Gastric bleeding is not rare and difficult to treat in gastric cancer patients. We investigated whether this affects survival and if successful bleeding control improves the prognosis.
Patients/Material And Methods:
We retrospectively reviewed medical records for 64 subjects who underwent endoscopic therapy for gastric cancer bleeding at Asan Medical Center from January 2012 to December 2014 (bleeding group). Each subject was matched 1:2 by age, sex, and American Joint Committee on Cancer staging with 128 randomly selected patients treated for stomach cancer during the same period (control group). Median survival, bleeding treatment methods, successful bleeding control, and rebleeding rate were investigated.
Results:
The median age was 58.5 years, the male to female ratio 4.3:1. The initial hemostasis rate was 73.4%. Most patients were treated with a single method (37 patients, 57.8%); the coagrasper (32/95 cases, 33.7%) was the most frequently used treatment. Among the 47 patients in which successful bleeding control was achieved, 17 (36.2%) experienced rebleeding after 3 days. The median survival was longer in the control than in the bleeding group (18.5 vs. 6.5 mo), and in the successful bleeding control than in the failed bleeding control group (8.5 vs. 1.8 mo). However, the successful bleeding control group had lower survival than the control group (18.5 vs. 8.5 mo). Multivariate analysis showed that the risk of bleeding was lower in Borrmann type II, IV cancer, but was higher in the patients using antiplatelet or anticoagulant.
Conclusions:
Successful bleeding control is essential for improving survival in bleeding gastric cancer patients.
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