title: Natural history of acute upper GI bleeding due to tumours: short-term success and long-term recurrence with or without endoscopic therapy.
abstract: BACKGROUND
  Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours.
  
  
  OBJECTIVE
  To determine the presentation, endoscopic findings, treatment and outcomes in patients with UGIB from malignant tumours and identify risk factors associated with rebleeding.
  
  
  METHODS
  Consecutive patients who were hospitalised with haematemesis, melena or haematochezia and underwent upper endoscopy were identified retrospectively by reviewing an endoscopy database. Patients with UGIB due to biopsy-proven malignant tumours were studied.
  
  
  RESULTS
  Tumours were the source of bleeding in 106 (5%) of 2,166 patients with UGIB. Tumours were oesophageal in 17 (16%), gastric in 77 (73%) and duodenal in 12 (11%). At presentation, 84 (79%) did not have known cancer previously, and 79 (75%) had metastatic disease. Seventy-seven (73%) received transfusions at index hospitalisation. At endoscopy, 32 (30%) had active bleeding (31 oozing, 1 spurting). Among actively bleeding patients, haemostasis was achieved in 12 (86%) of 14 receiving endoscopic therapy and all 18 not receiving endoscopic treatment. Hospitalisation for rebleeding occurred in 50 (49%) of 103 at a median of 30 days (3-885). On multivariate analysis, age ≤60 years (OR = 2.49, 95% CI 1.06-5.81) and haemodynamic instability (OR = 2.42, 95% CI 1.08-5.46) were associated with rebleeding.
  
  
  CONCLUSIONS
  Patients presenting with tumour-associated UGIB have substantial blood loss, with three-quarters requiring transfusion at presentation. Initial haemostasis occurs in almost all patients, with or without endoscopic therapy, but rebleeding requiring repeat hospitalisation occurs in approximately half the patients and is more common in patients who are ≤60 years of age and have haemodynamic instability at presentation.
authors.affiliation: Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sheibani
authors.forename: J J
authors.initials: JJ
authors.lastname: Kim
authors.forename: B
authors.initials: B
authors.lastname: Chen
authors.forename: S
authors.initials: S
authors.lastname: Park
authors.forename: B
authors.initials: B
authors.lastname: Saberi
authors.forename: K
authors.initials: K
authors.lastname: Keyashian
authors.forename: J
authors.initials: J
authors.lastname: Buxbaum
authors.forename: L
authors.initials: L
authors.lastname: Laine
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D004379:Duodenal Neoplasms / Q000150:complications* / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004938:Esophageal Neoplasms / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications* / Q000175:diagnosis; D013997:Time Factors