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Management of acute bleeding gastric malignancy
1Department of Gastrointestinal Surgery, Monash Medical Centre, Clayton, Victoria, Australia.
The Australian and New Zealand Journal of Surgery
|June 1, 1993
Summary
Gastric malignancy caused upper gastrointestinal bleeding in 1.5% of cases. Early endoscopy misdiagnosed malignant ulcers, leading to delayed treatment and similar mortality rates to benign gastric ulcers.
Area of Science:
- Gastroenterology
- Surgical Oncology
Background:
- Upper gastrointestinal hemorrhage is a common medical emergency.
- Gastric malignancy is an important, though less common, cause of upper gastrointestinal bleeding.
- Timely diagnosis and appropriate management are crucial for improving outcomes.
Purpose of the Study:
- To investigate the incidence and outcomes of gastric malignancy presenting as upper gastrointestinal bleeding.
- To evaluate the diagnostic accuracy of early endoscopy in identifying malignant ulcers.
- To identify predictors for urgent surgery in cases of malignant gastric ulcers.
Main Methods:
- Retrospective analysis of 2260 patients treated for upper gastrointestinal hemorrhage.
- Review of endoscopic findings, surgical interventions, and patient outcomes.
- Statistical analysis to identify predictors of urgent surgery and prognostic factors.
Main Results:
- Gastric malignancy accounted for 1.5% of upper gastrointestinal bleeding cases.
- Early endoscopy misdiagnosed malignant ulcers in 43% of cases, necessitating emergency surgery.
- Mortality rates for emergency surgery in malignant ulcers were comparable to those for benign gastric ulcers.
- Shock on admission and endoscopic signs of active bleeding were significant predictors of urgent surgery for malignant ulcers.
- A high resection rate (91%) was achieved for gastric malignancy.
- 68% of adenocarcinoma cases presented with localized disease (Stage I or II).
Conclusions:
- Gastric malignancy presents a diagnostic challenge in upper gastrointestinal bleeding, with a significant rate of misdiagnosis by early endoscopy.
- Urgent surgical intervention for malignant gastric ulcers, while sometimes necessary, is associated with outcomes similar to benign ulcers.
- Predictors like shock and active bleeding on endoscopy should prompt consideration of malignancy.
- High rates of resection and localized disease in adenocarcinoma suggest potential for improved survival with timely diagnosis and treatment.