Clin Endosc.  2015 Mar;48(2):121-127. 10.5946/ce.2015.48.2.121.

Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

• Kim YI
• Choi IJ

• KMID: 1801202
• DOI: http://doi.org/10.5946/ce.2015.48.2.121

Abstract

Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated.

Keyword

Stomach neoplasms; Hemorrhage; Endoscopic therapy

MeSH Terms

Christianity
Diagnosis
Endoscopy
Hemorrhage*
Hemostasis
Humans
Palliative Care
Proton Pump Inhibitors
Secondary Prevention
Stomach Neoplasms*
Proton Pump Inhibitors

Figure

• 

  Fig. 1 Endoscopic therapy for tumor bleeding due to inoperable gastric cancer using hemoclips. Hemoclips were applied for the spurting hemorrhage (A) from the tumor base at the angle of lesser curvature and achieved successful hemostasis (B).

• 

  Fig. 2 Endoscopic therapy using hemostatic forceps. Electrocoagulation using hemostatic forceps was carried out for the non-bleeding visible vessel on the base of malignant ulcer at the lower body lesser curvature (A) and controlled tumor bleeding (B).

• 

  Fig. 3 Endoscopic therapy using argon plasma coagulation. Diffuse oozing hemorrhages on the proximal margin of the gastric cancer at the pylorus (A) was controlled by electrocoagulation using argon plasma coagulation (B).

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