Pérez-Macías J P, Ramírez-Solís M E, Hernández-Guerrero A I, Dela Mora-Levy J G, Torrecilla-Ramírez W D, Sánchez-Jiménez B A, Salgado-Castellón G M
Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Tlalpan, Mexico City, Mexico.
Departamento de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, Tlalpan, Mexico City, Mexico.
Rev Gastroenterol Mex (Engl Ed). 2025 Apr-Jun;90(2):199-206. doi: 10.1016/j.rgmxen.2024.10.011. Epub 2025 Jun 9.
Upper gastrointestinal bleeding (UGIB) of neoplastic origin is a rare but life-threatening cause of bleeding. Endoscopic treatment is challenging due to diffuse oozing blood and high rates of rebleeding, despite coagulation and hemoclip use. Hemostatic powders can be an option in those patients. We aimed to determine the initial hemostatic rate and the rebleeding rate at 7 and 30 days, using hemostatic powders in patients with malignant UGIB at a national referral center in Mexico.
A retrospective, observational study was conducted on patients with malignant UGIB treated with hemostatic powder between 2018-2023. Demographic and clinical variables, endoscopic findings, and treatment results were analyzed. A central tendency analysis and the chi-square test were employed.
The study included 54 patients (54.7% were men), with a mean age of 54 years. A total of 40.7% were diagnosed with gastric cancer and presented with an episode of malignant UGIB. Of the endoscopic findings, 52% of patients had active malignant UGIB, most presenting with oozing bleeding (57.4%). EndoClot™ was the main monotherapy employed (81.5%), achieving initial homeostasis in 100% of cases. The rebleeding rate was 22.2% at 7 days and 44.4% at 30 days, with a 30-day accumulated mortality rate of 35.2%.
Malignant UGIB is a potentially life-threatening complication. Hemostatic powder use is highly recommendable due to its efficacy in the immediate control of bleeding. Nevertheless, its effect is temporary, suggesting its use as bridging therapy, facilitating bleeding stabilization and enabling the implementation of definitive hemostatic treatments.
肿瘤源性上消化道出血（UGIB）是一种罕见但危及生命的出血原因。尽管使用了凝血和止血夹，但由于弥漫性渗血和再出血率高，内镜治疗具有挑战性。止血粉可作为这些患者的一种选择。我们旨在确定在墨西哥一家国家转诊中心，使用止血粉治疗恶性UGIB患者的初始止血率以及7天和30天的再出血率。
对2018年至2023年期间接受止血粉治疗的恶性UGIB患者进行了一项回顾性观察研究。分析了人口统计学和临床变量、内镜检查结果及治疗结果。采用了集中趋势分析和卡方检验。
该研究纳入了54例患者（54.7%为男性），平均年龄54岁。共有40.7%被诊断为胃癌并出现恶性UGIB发作。在内镜检查结果中，52%的患者有活动性恶性UGIB，大多数表现为渗血（57.4%）。EndoClot™是主要采用的单一疗法（81.5%），100%的病例实现了初始止血。7天再出血率为22.2%，30天再出血率为44,4%，30天累积死亡率为35.2%。
恶性UGIB是一种潜在的危及生命的并发症。由于止血粉在立即控制出血方面的有效性，强烈推荐使用。然而，其效果是暂时的，这表明可将其用作桥接疗法，促进出血稳定并使确定性止血治疗得以实施。
