Acute upper gastrointestinal bleeding as primary symptom of gastric carcinoma

Little information is available regarding acute upper gastrointestinal bleeding as a presenting sign of gastric carcinoma. Of 427 patients with gastric cancer, 36 (8.4%) underwent early endoscopy due to hematemesis. The hemorrhage was self-limited in 16 patients (44.4%), most of whom underwent elective surgery. Twenty patients (55.6%) had persistent or massive bleeding, and 13 of these underwent early surgery with a surgical mortality of 3 cases (23.1%); the remaining 7 patients were not operated on, and died secondary to the hemorrhage. The total mortality rose to 10 patients (27.7%). The mean age was higher in patients with persistent or massive bleeding, mainly in those who did not undergo surgery and died. We conclude that the immediate outcome is related to age and previous general condition, rather than to the definite diagnosis of gastric cancer. Moreover, emergency endoscopy may be useful in determining the exact source of hemorrhage and in identifying potential candidates for emergency surgery.