Allo Gabriel, Bürger Martin, Chon Seung-Hun, Gülcicegi Dilan, Krämer Laurenz, Goeser Tobias, Kütting Fabian
Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of General, Visceral and Cancer and Transplant Surgery, University Hospital of Cologne, University of Cologne, Cologne, Germany.
Scand J Gastroenterol. 2023 Jul-Dec;58(9):1064-1070. doi: 10.1080/00365521.2023.2199439. Epub 2023 Apr 8.
Upper gastrointestinal bleeding (UGIB) from malignancies is associated with a poor outcome. Only a small number of studies on gastrointestinal tumor bleeding have been published so far, focusing mainly on bleeding from gastric cancer. Since the information on patients with UGIB from esophageal cancer appears insufficient, this study aimed to present clinical and endoscopic findings, treatment options as well as clinical outcomes such as rebleeding and survival of those patients.
This retrospective analysis included all patients admitted with UGIB from esophageal cancer at our university hospital during a 10-year period.
45 patients were analyzed of whom 26 (57.8%) already had cancer stage IV at index bleeding. 22 (48.9%) patients presented with hemodynamic instability and 30 (66.7%) patients received blood transfusions. Active bleeding was present in 24 (53.3%) patients, of whom 20 (83.3%) received endoscopic therapy. Successful hemostasis was achieved in 18 (90%) of 20 patients with Argon plasma coagulation used most frequently (52.4%). Early and delayed rebleeding occurred in 5 (12.5%) and 11 (27.5%) of all inoperable patients, respectively. Intake of anticoagulation or anti-platelet drugs were risk factors for delayed rebleeding and the median overall survival after index bleeding was 1.2 months.
UGIB from esophageal cancer occurred most frequently in advanced tumor stages and was associated with significant blood loss. Even though initial endoscopic therapy was effective, rebleeding occurred in a significant number of patients. Those taking anticoagulants or anti-platelet drugs should be closely monitored for rebleeding. The overall survival after index bleeding was poor.
恶性肿瘤引起的上消化道出血（UGIB）预后较差。迄今为止，关于胃肠道肿瘤出血的研究较少，主要集中在胃癌出血方面。由于食管癌所致UGIB患者的相关信息似乎不足，本研究旨在呈现此类患者的临床及内镜检查结果、治疗选择以及再出血和生存等临床结局。
本回顾性分析纳入了我校医院10年间收治的所有因食管癌导致UGIB的患者。
共分析了45例患者，其中26例（57.8%）在初次出血时已处于癌症IV期。22例（48.9%）患者出现血流动力学不稳定，30例（66.7%）患者接受了输血治疗。24例（53.3%）患者存在活动性出血，其中20例（83.3%）接受了内镜治疗。20例接受内镜治疗的患者中有18例（90%）成功止血，最常使用的是氩离子凝固术（52.4%）。所有无法手术的患者中，早期再出血和延迟再出血分别发生在5例（12.5%）和11例（27.5%）。服用抗凝药或抗血小板药物是延迟再出血的危险因素，初次出血后的中位总生存期为1.2个月。
食管癌所致UGIB最常发生于肿瘤晚期，且伴有大量失血。尽管初始内镜治疗有效，但仍有相当数量的患者发生再出血。服用抗凝药或抗血小板药物的患者应密切监测再出血情况。初次出血后的总体生存率较差。
