ENDOSCOPIC TREATMENT OF MAJOR BLEEDING FROM ADVANCED GASTRODUODENAL MALIGNANT LESIONS

Objective: To summarize the results of endoscopic therapy for acute he morrhage from gastroduodenal malignant lesions. Design: The 3-year exp erience (1989 through 1991) of a specialized gastrointestinal (GI) ble eding team in the endoscopic treatment of acute upper GI bleeding from gastroduodenal malignant tumors was retrospectively reviewed. Materia l and Methods: Of 1,083 consecutive patients with acute major upper GI hemorrhage, 21 (1.9%) were found to have advanced tumors of the stoma ch and duodenum, 15 of whom received endoscopic therapy. In this study group of 15 patients, the tumors were gastric in 11 and duodenal in 4 . Endoscopic treatment consisted of injection of epinephrine, heater p robe coagulation, neodymium:yttrium-aluminum-garnet laser coagulation, or injection of sodium tetradecyl sulfate. Results: Initial endoscopi c hemostasis was achieved in 10 of the 15 patients (67%); however, ble eding recurred in 8 of 10 (80%), and all 5 in whom endoscopic hemostas is was not achieved continued to bleed. Mean transfusion requirements for the 30 days before and the 30 days after the first endoscopic trea tment were 7.6 and 6.4 units of packed erythrocytes, respectively (P>0 .10). Five major procedure-related complications occurred, two of whic h were fatal. The median duration of survival after the first endoscop ic treatment was 39 days (range, 1 to 1,414). Conclusion: In patients with major bleeding from advanced gastroduodenal malignant lesions, en doscopic therapy seems to provide limited benefit.