Gastrointestinal bleeding in patients with pancreatic cancer: Causes and haemostatic treatments

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Gastrointestinal bleeding is a rare but severe complication of pancreatic ductal adenocarcinoma. </jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this study was to describe the causes and treatments of non-postoperative gastrointestinal bleeding in patients with pancreatic ductal adenocarcinoma, and explore the parameters associated with therapeutic effectiveness. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> This was a single-centre observational retrospective study (2000–2017) with data collected from the prospectively coded diagnostic hospital’s database system including patients with pancreatic ductal adenocarcinoma who had a gastrointestinal bleeding episode. Effectiveness of haemostatic treatment was assessed according to transfusion requirements and immediate and long-term haemostatic efficacy; the latter defined as no bleeding recurrence. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The population included 72 patients with pancreatic ductal adenocarcinoma who had 94 episodes of gastrointestinal bleeding. The main causes of gastrointestinal bleeding were gastroduodenal tumour invasion (56.4%) and oesophageal variceal bleeding due to left-sided portal hypertension (19.1%). In cases of gastrointestinal bleeding caused by tumour invasion, the main treatment was therapeutic endoscopy (41.5%). Among patients who had gastrointestinal bleeding by tumour invasion treated by endoscopy or radiation therapy, haemostatic immediate efficacy rates were 70.6% and 100%, respectively. Bleeding recurrence rates were 35.3% and 25.0%, for patients treated by endoscopy or radiation therapy, respectively, for a first episode of gastrointestinal bleeding by tumour invasion. Transfusion requirements, before and after treatment, were not different in patients treated by haemostatic radiation therapy for gastrointestinal bleeding by tumour invasion compared to other treatments (odds ratio 0.3, 95% CI (0.06–1.59); p = 0.16). The median survival after all-cause gastrointestinal bleeding was 2.72 months (1.43–4.01). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Gastroduodenal tumour invasion was the main cause of gastrointestinal bleeding in patients with pancreatic ductal adenocarcinoma; haemostatic radiation therapy is a potential interesting option for gastrointestinal bleeding treatment in this context. </jats:p></jats:sec>

Palliative radiotherapy for tumor bleeding in patients with unresectable pancreatic cancer: a single-center retrospective study

“…In our present study, hemostasis was achieved in 14 out of 20 patients (70%), which was consistent with previous reports of rates ranging from 54-73% from studies conducted in gastric cancer patients [13,[15][16][17]. Aguilera ML et al, who performed a comprehensive study of the causes and treatments of GIB in PC patients, reported that PRT was associated with a hemostasis rate of 100% (8/8) [4]. However, in their study, hemostasis was de ned solely on the basis of the reduced volume of RBC transfusion needed after PRT as compared with that before PRT.…”

Pancreatic Adenosquamous Carcinoma Presenting as a Gastric Lesion

“…A study has shown that radiation therapy in comparison with endoscopic treatment caused less recurrence and higher immediate efficacy in hemostasis in patients with GI bleeding due to gastric invasion of pancreatic cancer. 10 Our patient had complete cessation of bleeding with palliative radiotherapy but unfortunately died of complications of the progressive disease. More knowledge on PASC including appropriate treatment strategies and different forms of clinical presentations is still needed to increase the rate of overall patient survival.…”

Effectiveness and Safety of Lower Dose of Rivaroxaban for Cancer-Related Venous Thromboembolism: A Retrospective Cohort Study

“…8 In patients with pancreatic cancer, the risk of gastrointestinal bleeding may be higher when the tumor invades the gastrointestinal tract. 15 In our study, tumor invasion to the gastrointestinal tract was observed in both patients with pancreatic cancer and gastrointestinal bleeding. From the data in clinical trials and our study, rivaroxaban was associated with higher major bleeding risk in patients with gastrointestinal cancer and pancreatic cancer, so the use of rivaroxaban in this population should be cautious.…”