title: Outcome of endoscopic therapy for cancer bleeding in patients with unresectable gastric cancer.
abstract: OBJECTIVE
  Gastric cancer bleeding is not rare complication in patients with advanced gastric cancer (AGC). The aim of this study was to evaluate the efficacy and clinical outcomes of endoscopic therapy (ET) for upper gastrointestinal bleeding (UGIB) from unresectable AGC.
  
  
  METHODS
  Data from 113 patients with UGIB from unresectable AGC who underwent ET at the National Cancer Center, Korea were analyzed retrospectively. Success rates of endoscopic hemostasis, rebleeding rates, mortality at 30 days, and overall survival (OS) rate after initial hemostasis were investigated.
  
  
  RESULTS
  The initial hemostasis rate was 92.9% (105/113). Electrocoagulation was the most common method used (92.0%, 104/113), and combination ET was required in 34 patients (30.1%). Rebleeding occurred in 43 patients (41.0%); 3-day and 30-day rebleeding rates were 18.1% and 29.5%, respectively. Multivariate logistic regression analysis showed that transfusion of packed red blood cells (> 5 units) was associated with early rebleeding (≤ 3 days after initial hemostasis) (odd ratio, 4.75; 95% confidential interval, 1.45-15.57; P = 0.010). ET was attempted in 18 patients with rebleeding; hemostasis was achieved in 88.9%. The 30-day mortality rate after initial bleeding event was 15.9%. Median OS after initial hemostasis was 3.2 months. OS was lower for patients with early rebleeding than for those with late rebleeding (> 3 days after initial hemostasis) or without rebleeding (1.0, 3.1, and 4.3 months, respectively; P = 0.004).
  
  
  CONCLUSIONS
  ET, primarily endoscopic electrocoagulation, achieved a high initial hemostasis rate for UGIB in patients with unresectable AGC. However, rebleeding frequently occurred, and early rebleeding was associated with poor survival.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Goyang, Korea; School of Life Sciences and Immune Synapse Research Center, Gwangju Institute of Science and Technology (GIST), Gwangju, Korea.
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Kim
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Cho
authors.forename: Jong Yeul
authors.initials: JY
authors.lastname: Lee
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.forename: Mi-Jung
authors.initials: MJ
authors.lastname: Kim
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
authors.forename: Young Iee
authors.initials: YI
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004564:Electrocoagulation / Q000379:methods; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: bleeding; endoscopy; gastric cancer; hemostasis