[Factors related to acute upper gastrointestinal bleeding after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma].
OBJECTIVE
Acute upper gastrointestinal bleeding (UGIB) often occurs after transcatheter arterial chemoembolization (TACE) in the patients with hepatocellular carcinoma (HCC). The authors studied the factors associated with UGIB for better prevention and management of the complication.


METHODS
Epirubicin, cisplatin, mitomycin, 5-fluorouracil, lipidol and/or gelfoam were infused via catheters inserted in ciliac artery, common hepatic artery, arteria hepatica propria, or left or right hepatic artery by Seidinger method in 208 cases of advanced HCC confirmed by image techniques, alpha-fetoprotein (AFP) and/or pathology. Factors related to UGIB (vomiting of blood and/or melena, or positive fecal occult blood) were analyzed with reference to endoscopy, biochemical parameters of liver function, selection of blood vessels, and the amount of drugs.


RESULTS
Of 208 patients, 31 cases were complicated with UGIB. Acute gastric mucosal lesion was confirmed in 18 cases; acute ulcer in 3 cases; Mallory-Weiss syndrome in 3 cases; and esophageal varices bleeding in 2 cases. Positive correlation was found between B grade of Child-Pugh hepatic functional reserve and bleeding (r = 0.59, P < 0.005). The incidence of UGIB in patients in whom drugs were infused via ciliac artery (7/18, 38.9%); or common hepatic artery (18/38, 47.4%) was significantly higher than in those via arteria hepatica propria, left, or right hepatic artery (5/146, 3.4%; P < 0.005). Patients with larger amount of chemotherapy drug and embolization agent had higher bleeding rate.


CONCLUSIONS
Many factors may be associated with UGIB after TACE in patients with HCC, such as higher scores of hepatic functional reserve in Child-Pugh grading, selection of blood vessels, and amount of drugs. In order to reduce the incidence of UGIB, these factors should be necessarily considered in improvement of TACE procedure, in inspection and management after TACE.
Wu
Jian-xin
JX
Department of Gastroenterology, Xinhua Hospital, Shanghai Second Medical University, Shanghai 200092, P. R. China. wjxgp@public9.sta.net.cn
Huang
Jie-fei
JF
Yu
Zhi-jian
ZJ
Meng
Xian-yong
XY
Li
Ding-guo
DG
Lu
Han-ming
HM
D000208:Acute Disease; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors