13th Annual Global Embolization Symposium & Technologies
Purpose : Acute upper gastrointestinal (GI) bleeding is a life threatening emergency in patients with gastric cancer. Endoscopic hemostasis is the first-line modality but is associated with a high rate of re-bleeding because of larger tumor sizes. Our purpose was to evaluate the role of Trans-arterial embolization (TAE) as a first treatment option for treating gastric cancer related bleeding.
Material and Methods : This is a retrospective study including 10 patients (all men; age 50.2 y ± 8.4) with unresectable gastric cancer related acute upper GI bleeding who underwent TAE between March 2017 and October 2018 at our hospital in the division of Interventional Radiology. The patient's Clinical course, laboratory findings, and arterial embolization findings were reviewed. All the patients were unresectable at presentation and had been undergoing chemotherapy and other supportive management at our hospital. They all presented with massive GI upper bleed with drop in blood Hemoglobin levels (Range 3-6 g/dL). All the patients presented with malena and 2 patients additionally had hematemesis also. 4 patients had previously complained of intermittent trivial malena. They had undergone endoscopic evaluation and the findings were evidence of recent tumor bleed with no endoscopic management done. At presentation all patients were taken upfront for TAE in view of the critical condition of the patients. Technical success of arterial embolization was defined as cessation of tumor blush, and clinical success was defined as bleeding cessation with hemodynamic stability during 72 hours after TAE and absence of signs and symptoms of haemorrhage for at least 30 days following embolization. Data was reviewed to identify various aspects of successful TAE, 30-day survival and long term follow up after embolization and its complications.
Results : TAE was performed in 10 patients. Technical and clinical success rates of TAE were 100% and 100%, respectively. Small splenic infarctions occurred in 1 patient as a minor complication. 2 patients complained of chest pain, post procedurally & were managed conservatively. 3 patients had evidence of re-bleeding after 2-4 months and a repeat TAE was done which controlled the bleeding again. Death related to disease progression occurred in 3 patients during this time.
Conclusions : TAE for gastric cancer–associated GI bleeding is a lifesaving procedure which should be used as a first line management option for such patients and can be easily repeated in case of re-bleeding