Gastrointestinal Bleeding in the Cancer Patient

Yarris, Jonathan P.; Warden, Craig R.

doi:10.1016/j.emc.2009.04.011

Cited by 33 publications

(20 citation statements)

References 86 publications

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“…Further support comes from the findings of Jae et al [16], who reported a clinical success rate of 91% in 32 patients, 25% of whom had underlying cancer; however, in another study involving 23 patients with bleeding associated with gastric cancer, the clinical success rate was only 52% [24]. Cancer-related bleeding seems to be much more difficult to control than other causes of bleeding, not only because of direct cancer invasion into adjacent vascular structures, but also because of severe mucositis caused by chemotherapy or radiation that can induce vascular erosion or tissue necrosis [25][26][27]. Several previous studies have analyzed the factors affecting clinical outcome after TAE using various embolic materials for gastrointestinal tract bleeding, and the results suggested that a high bleeding tendency was associated with a higher risk of early bleeding recurrence [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Koo

Shin

Kim

et al. 2015

American Journal of Roentgenology

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ing, renal arterial bleeding, and even gastrointestinal tract bleeding [2][3][4][5][6][7][8]. NBCA is highly penetrable because of its liquid nature and is less affected by coagulopathies; thus, it may be used as an adjunct to other embolic materials to ensure the embolic effect [9,10]. However, NBCA is difficult to handle effectively and safely and is inherently more prone to cause ischemic necrosis.Although there have been several reports on the use of TAE with NBCA for acute gastrointestinal tract bleeding, 9-84 patients were included in those studies, and neither long-term clinical data nor analyses evaluating clinical factors affecting the clinical success of NBCA were presented [11][12][13][14][15][16]. Therefore, studies in larger patient populations are warranted to determine the clinical effectiveness of NBCA in the setting of acute gastrointestinal tract bleeding, with or AJR 2015; 204:662-668 0361-803X/15/2043-662 © American Roentgen Ray Society E ndoscopy is a rapid diagnostic and therapeutic modality that is widely accepted as the preferred method for identifying and providing hemostasis at sites of gastrointestinal tract bleeding. In cases of endoscopic treatment failure or where the site of bleeding is inaccessible by endoscopy, such as distal small-bowel bleeding, transcatheter arterial embolization (TAE) may be an effective alternative to endoscopy. A previous study showed that TAE in the management of gastrointestinal tract bleeding is effective with good long-term clinical outcomes [1]. Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • O r ig i n a l R e s e a rc hAmong the various embolic materials that have been evaluated, N-butyl-2-cyanoacrylate (NBCA) was first used to embolize cerebral aneurysms but now is widely used for controlling active bleeding, including intramuscular hemorrhage, uterine arterial bleed- OBJECTIVE. The purpose of this article is to evaluate the clinical effectiveness of transcatheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA), with or without other embolic materials for acute nonvariceal gastrointestinal tract bleeding, and to determine the factors associated with clinical outcomes.MATERIALS AND METHODS. TAE using NBCA only or in conjunction with other materials was performed for 102 patients (80 male and 22 female patients; mean age, 61.3 years) with acute nonvariceal gastrointestinal tract bleeding. Technical success, clinical success, and clinical factors, including age, sex, bleeding tendency, endoscopic attempts at hemostasis, number of transfusions, and bleeding causes (i.e., cancer vs noncancer), were retrospectively evaluated. Univariate and multivariable logistic regression analyses were performed to evaluate clinical factors and their ability to predict patient outcomes. Survival curves were obtained using Kaplan-Meier analyses and log-rank tests.RESULTS. There were 36 patients with cancer-related bleeding and 66 with non-cancerrelated bleeding. Overall technical and clinical success rates were 100% (102/102) and 76.5% ...

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Koo

Shin

Kim

et al. 2015

American Journal of Roentgenology

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“…Many authors argue that the etiology of upper gastrointestinal bleeding in oncological patients is the same as in the general population, with peptic ulcersmost commonly caused by acute blood loss, esophageal and gastric varices, and esophagitis and erosive lesions [5]. In this context, acute bleeding stemming directly from the tumor itself would be a less common event (2.9% to 4% of all cases), since these patients commonly present chronic blood loss [6].…”

Section: Etiology Of Upper Gastrointestinal Bleeding In Patients Withmentioning

confidence: 99%

“…Patients with cancer can benefit from early surgical procedures to control bleeding, especially if endoscopic treatment is not possible. Despite the improvement in the mortality rates with surgery, curative ressecton is relatively uncommon and post-operative complications are common [5]. …”

Section: Surgerymentioning

confidence: 99%

“…The need for blood transfusions is individual, with no level of hemoglobin presenting an absolute indication, with the requirements determined by various factors, including age, presence of comorbidities, cardiovascular state, basal hemoglobin, and volume of blood, together with the current level of hemoglobin. Red blood cell concentrates should be transfused in patients who present an excessive blood loss, who present persistent active bleeding, and who present signs of cardiac, renal, or cerebral hypoperfusion [5,11]. Patients who present hemodynamic instability associated with active bleeding or recent engina are recommended for early blood transfusion.…”

Section: Blood Transfusionmentioning

confidence: 99%

“…In patients that, when undergoing an endoscopy, do not present active bleeding, ulcers with visible blood vessels or adhered coagulation (i.e., low risk for rebleeding), the treatment can be started with the oral administration of PPIs. It is suggested that omeprazole be used at a dose of 80 mg, intravenously, in bolus, followed by an infusion of 8 mg/h, for 72 hours, at which time it should be exchanged for 20 mg, administered orally (once per day) for eight weeks [5,27]. The suspension of the medication after this period will depend on the correction of the percipient factors, such as H. pylori, NSAIDs, and acetylsalicylic acid (ASA).…”

Section: Clinical Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Upper Gastrointestinal Bleeding in Oncological Patients

Alberti

Santos

Àlex

et al. 2016

GHOA

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Bleeding is a relatively common phenomenon in patients with solid neoplasms, occurring in up to 10% of all patients in advanced stages of cancer. Therefore, this study aims to discuss clinical support management, endoscopic strategies, radiotherapy, chemotherapy, as well as endovascular and surgical interventions. AbstractBleeding is a relatively common phenomenon in patients with solid neoplasms, occurring in up to 10% of all patients in advanced stages of cancer. The objective of this article is to review the etiology, clinical manifestations, and treatment of acute upper gastrointestinal bleeding in cancer patients, understanding that chronic and occult blood losses are not within the scope of this text. To achieve better outcomes in the management of this entity, a multidisciplinary approach is mandatory. Therefore, this study aims to discuss clinical support management, endoscopic strategies, radiotherapy, chemotherapy, as well as endovascular and surgical interventions.

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Palliative and Emergency Surgery in Gastric Cancer

Orsenigo

Bencivenga

2021

Gastric Cancer: The 25-Year R-Evolution

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Gastrointestinal Bleeding in the Cancer Patient

Cited by 33 publications

References 86 publications

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Clinical Outcome of Transcatheter Arterial Embolization With N-Butyl-2-Cyanoacrylate for Control of Acute Gastrointestinal Tract Bleeding

Upper Gastrointestinal Bleeding in Oncological Patients

Palliative and Emergency Surgery in Gastric Cancer

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