Efficacy of endoscopic therapy and long-term outcomes of upper gastrointestinal tumor bleeding in patients with esophageal cancer

Abstract

Background

Upper gastrointestinal bleeding (UGIB) from malignancies is associated with a poor outcome. Only a small number of studies on gastrointestinal tumor bleeding have been published so far, focusing mainly on bleeding from gastric cancer. Since the information on patients with UGIB from esophageal cancer appears insufficient, this study aimed to present clinical and endoscopic findings, treatment options as well as clinical outcomes such as rebleeding and survival of those patients.

Methods

This retrospective analysis included all patients admitted with UGIB from esophageal cancer at our university hospital during a 10-year period.

Results

45 patients were analyzed of whom 26 (57.8%) already had cancer stage IV at index bleeding. 22 (48.9%) patients presented with hemodynamic instability and 30 (66.7%) patients received blood transfusions. Active bleeding was present in 24 (53.3%) patients, of whom 20 (83.3%) received endoscopic therapy. Successful hemostasis was achieved in 18 (90%) of 20 patients with Argon plasma coagulation used most frequently (52.4%). Early and delayed rebleeding occurred in 5 (12.5%) and 11 (27.5%) of all inoperable patients, respectively. Intake of anticoagulation or anti-platelet drugs were risk factors for delayed rebleeding and the median overall survival after index bleeding was 1.2 months.

Conclusion

UGIB from esophageal cancer occurred most frequently in advanced tumor stages and was associated with significant blood loss. Even though initial endoscopic therapy was effective, rebleeding occurred in a significant number of patients. Those taking anticoagulants or anti-platelet drugs should be closely monitored for rebleeding. The overall survival after index bleeding was poor.

Keywords:

• Esophageal cancer
• upper gastrointestinal bleeding
• endoscopic therapy

Acknowledgments

None.

Authors contributions

Conceptualization, T.G.; F.K., S-H.C., M.B. and G.A.; methodology, G.A., F.K. and S-H.C.; analysis, G.A., L.K. and D.G.; investigation, G.A., L.K. and D.G.; writing—original draft preparation, G.A. and F.K; writing—review and editing, L.K., D.G., S-H.C., M.B. and T.G.; supervision, T.G.; project administration, T.G., F.K.

Disclosure statement

Fabian Kütting received speaker’s honoraria from Bayer, Ipsen, MSD, Eisai, Shire, Sirtex and travel grants from Eisai, Janssen, Ipsen, Novartis, Celgene unrelated to present work. Martin Bürger obtained consulting fees from Janssen and travel support from Pfizer unrelated to present work. Other authors declare no conflict of interest.

Informed consent statement

Patient consent was waived by the Ethics Committee of the Faculty of Medicine, University Hospital of Cologne due to the retrospective non-interventional study design.

Institutional review board statement

The study was conducted in accordance with the Declaration of Helsinki, and Ethical approval was waived by the Ethics Committee of the Faculty of Medicine, University Hospital of Cologne due to the retrospective non-interventional study design.

Data availability statement

The data presented in this study are available on reasonable request from the corresponding author.

Additional information

Funding

This research received no external funding.