title: Etiology, endoscopic management and mortality of upper gastrointestinal bleeding in patients with cancer.
abstract: BACKGROUND
  The source and outcomes of upper gastrointestinal bleeding (UGIB) in oncologic patients are poorly investigated.
  
  
  OBJECTIVE
  The study aimed to investigate these issues in a tertiary academic referral center specialized in cancer treatment.
  
  
  METHODS
  This was a retrospective study including all patients with cancer referred to endoscopy due to UGIB in 2010.
  
  
  RESULTS
  UGIB was confirmed in 147 (of 324 patients) referred to endoscopy for a suspected episode of GI bleeding. Tumor was the most common cause of bleeding (N = 35, 23.8%), followed by varices (N = 30, 19.7%), peptic ulcer (N = 29, 16.3%) and gastroduodenal erosions (N = 16, 10.9%). Among the 32 patients with cancer of the upper GI tract, the main causes of bleeding were cancer (N = 27, 84.4%) and peptic ulcer (N = 5, 6.3%). Forty-one patients (27.9%) presented with bleeding from the primary tumor or from a metastatic lesion, and seven received endoscopic therapy, with successful initial hemostasis in six (85.7%). Rebleeding and mortality rates were not different between endoscopically treated (N = 7) and non-treated (N = 34) patients (28.6% vs. 14.7%, p = 0.342; 43.9% vs. 44.1%, p = 0.677). Median survival was 20 days, and the overall 30-day mortality rate was 44.9%. There was no predictive factor of mortality or rebleeding.
  
  
  CONCLUSIONS
  Tumor bleeding is the most common cause of UGIB in cancer patients. UGIB in cancer patients correlates with a high mortality rate regardless of the bleeding source. Current endoscopic treatments may not be effective in preventing rebleeding or improving survival.
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Fauze
authors.initials: F
authors.lastname: Maluf-Filho
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Bruno Costa
authors.initials: BC
authors.lastname: Martins
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Marcelo Simas
authors.initials: MS
authors.lastname: de Lima
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Daniel Valdivia
authors.initials: DV
authors.lastname: Leonardo
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Felipe Alves
authors.initials: FA
authors.lastname: Retes
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Fábio Shiguehissa
authors.initials: FS
authors.lastname: Kawaguti
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Cezar Fabiano Manabu
authors.initials: CF
authors.lastname: Sato
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Fábio Yuji
authors.initials: FY
authors.lastname: Hondo
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Adriana Vaz
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.affiliation: Department of Gastroenterology, Cancer Institute of São Paulo University Medical School, São Paulo, Brazil.
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro
keywords: Gastrointestinal hemorrhage; endoscopy; gastrointestinal; human; neoplasms