Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA.
Aliment Pharmacol Ther. 2013 Jul;38(2):144-50. doi: 10.1111/apt.12347. Epub 2013 May 28.
Scant information is available regarding patients with upper gastrointestinal bleeding (UGIB) from tumours.
To determine the presentation, endoscopic findings, treatment and outcomes in patients with UGIB from malignant tumours and identify risk factors associated with rebleeding.
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.
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.
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.
关于肿瘤引起的上消化道出血（UGIB）患者的信息很少。
确定 UGIB 由恶性肿瘤引起的患者的表现、内镜检查结果、治疗和结果，并确定与再出血相关的危险因素。
通过回顾内镜数据库，回顾性确定因呕血、黑便或血便住院并接受内镜检查的连续患者。研究 UGIB 由经活检证实的恶性肿瘤引起的患者。
在 2166 例 UGIB 患者中，有 106 例（5%）肿瘤为出血源。肿瘤位于食管 17 例（16%），胃 77 例（73%），十二指肠 12 例（11%）。在就诊时，84 例（79%）之前没有明确的癌症，79 例（75%）有转移疾病。77 例（73%）在入院时接受输血。在内镜检查时，有 32 例（30%）有活动性出血（31 例渗出，1 例喷射）。在活动性出血的患者中，14 例接受内镜治疗的患者中有 12 例（86%）达到止血，所有 18 例未接受内镜治疗的患者均达到止血。中位时间为 30 天（3-885），103 例中有 50 例（49%）因再出血而住院。多变量分析显示，年龄≤60 岁（OR=2.49，95%CI 1.06-5.81）和血流动力学不稳定（OR=2.42，95%CI 1.08-5.46）与再出血相关。
出现肿瘤相关 UGIB 的患者有大量失血，其中四分之三的患者在就诊时需要输血。几乎所有患者都有初始止血，无论是否接受内镜治疗，但需要再次住院的再出血在大约一半的患者中发生，并且在就诊时年龄≤60 岁且血流动力学不稳定的患者中更常见。
