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Kubo K, Zhang X, Tanaka I, Kimura N. Emergency Endoscopic Hemostasis Using the Endoscopic Mucosal Resection Technique for Severe Bleeding From Early Gastric Cancer: A Case Report. Cureus 2024; 16:e54429. [PMID: 38510882 PMCID: PMC10951553 DOI: 10.7759/cureus.54429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
Bleeding from gastric cancer may lead to severe anemia and hypovolemic shock, and can be a life-threatening condition in affected patients; thus, achieving hemostasis is essential to improving their clinical course. While endoscopic hemostasis is recommended as the hemostatic modality of first choice, endoscopic hemostasis involving the endoscopic mucosal resection (EMR) technique is also being used, though under-reported. An 85-year-old man diagnosed with bleeding from gastric cancer was raced to our hospital for hemostasis. Emergency esophagogastroduodenoscopy (EGD) revealed a 45 mm-sized elevated lesion involving the coagula due to dripping bleeding from the surface of the posterior wall of the gastric lower body. EMR was performed without any technical difficulty, and hemostasis was achieved immediately. The patient was discharged without rebleeding. This case appears to support the usefulness of EMR as an emergency endoscopic hemostatic modality for severe bleeding from early gastric cancer.
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Affiliation(s)
- Kimitoshi Kubo
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, JPN
| | - Xinhan Zhang
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, JPN
| | - Ikko Tanaka
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, JPN
| | - Noriko Kimura
- Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, JPN
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2
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Tarasov SA, Yartsev PA, Rogal MM, Aksenova SO. [Complicated gastric cancer and modern treatment approaches]. Khirurgiia (Mosk) 2024:125-140. [PMID: 38634594 DOI: 10.17116/hirurgia2024041125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Among all patients with gastric cancer, 40% admit to the hospitals due to cancer-related complications. The most common complications of gastric cancer are bleeding (22-80%), malignant gastric outlet obstruction (26-60%), and perforation (less than 5%). The main treatment methods for gastric cancer complicated by bleeding are various forms of endoscopic hemostasis, transarterial embolization and external beam radiotherapy. Surgical treatment is possible in case of ineffective management. However, surgical algorithm is not standardized. Malignant gastric outlet stenosis requires decompression: endoscopic stenting, palliative gastroenterostomy. Surgical treatment is also possible (gastrectomy, proximal or distal resection of the stomach). The main problem for patients with complicated gastric cancer is the lack of standardized algorithms and abundance of potential surgical techniques. The aim of our review is to systematize available data on the treatment of complicated gastric cancer and to standardize existing methods.
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Affiliation(s)
- S A Tarasov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - P A Yartsev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - M M Rogal
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - S O Aksenova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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3
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Su DS, Li CK, Gao C, Qi XS. Hemostatic powder for acute upper gastrointestinal bleeding: Recent research advances. Shijie Huaren Xiaohua Zazhi 2023; 31:249-255. [DOI: 10.11569/wcjd.v31.i7.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Acute upper gastrointestinal bleeding (AUGIB) is a clinically common emergency condition. The common causes of AUGIB are peptic ulcer and esophagogastric variceal bleeding. Despite continuous improvements in endoscopic hemostasis techniques, endoscopic treatment is still unsuccessful in 5%-15% of patients. Hemostatic powder, a new drug for endoscopic hemostasis that is sprayed on the bleeding site with the assistance of an air pump, can absorb water to promote clotting substance aggregation and then adhere over the lesion, forming a mechanical barrier and then achieving hemostasis. It is convenient to spray hemostatic powder under endoscopy, where precise positioning is not warranted. The immediate hemostasis rate of hemostatic powder is often high, and it can be used as a remedy after the failure of conventional hemostasis. However, until now, there have been no recommendations in China regarding the use of hemostatic powder for the treatment of AUGIB. This article summarizes the mechanism, clinical applicability, and side effects of five major types of hemostatic powder by reviewing the existing evidence, with an aim to strengthen endoscopists' understanding of this drug.
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4
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Ota N, Adachi A, Oike T, Hisatake Y, Higashizawa T, Teramoto K, Okamura Y, Ohno T. Palliative radiation therapy for bleeding from gastric cancer: A case series of seven patients. Clin Case Rep 2023; 11:e6955. [PMID: 36789299 PMCID: PMC9913188 DOI: 10.1002/ccr3.6955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 02/12/2023] Open
Abstract
The hemostatic effect of palliative radiation therapy (RT) for unresectable gastric cancer is unclear. We performed palliative RT (20 Gy in 5 fractions or 30 Gy in 10 fractions) in 7 consecutive patients with bleeding. The number of blood transfusions decreased significantly post-RT, supporting the hemostatic effect of palliative RT.
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Affiliation(s)
- Norichika Ota
- Department of Radiation OncologySano Kosei General HospitalSanoJapan,Department of Radiation OncologyGunma University HospitalMaebashiJapan,Department of Radiation OncologyGunma University Graduate School of Medicine School of Medicine Faculty of MedicineMaebashiJapan
| | - Akiko Adachi
- Department of Radiation OncologySano Kosei General HospitalSanoJapan,Department of Radiation OncologyGunma University HospitalMaebashiJapan,Department of Radiation OncologyGunma University Graduate School of Medicine School of Medicine Faculty of MedicineMaebashiJapan,Gunma University Heavy Ion Medical CenterMaebashiJapan
| | - Takahiro Oike
- Department of Radiation OncologySano Kosei General HospitalSanoJapan,Department of Radiation OncologyGunma University HospitalMaebashiJapan,Department of Radiation OncologyGunma University Graduate School of Medicine School of Medicine Faculty of MedicineMaebashiJapan,Gunma University Heavy Ion Medical CenterMaebashiJapan
| | - Yuta Hisatake
- Department of GastroenterologySano Kosei General HospitalSanoJapan
| | | | - Ken Teramoto
- Department of GastroenterologySano Kosei General HospitalSanoJapan
| | | | - Tatsuya Ohno
- Department of Radiation OncologySano Kosei General HospitalSanoJapan,Department of Radiation OncologyGunma University HospitalMaebashiJapan,Department of Radiation OncologyGunma University Graduate School of Medicine School of Medicine Faculty of MedicineMaebashiJapan,Gunma University Heavy Ion Medical CenterMaebashiJapan
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5
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Karna R, Deliwala S, Ramgopal B, Mohan BP, Kassab L, Becq A, Dhawan M, Adler DG. Efficacy of topical hemostatic agents in malignancy-related GI bleeding: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97:202-208.e8. [PMID: 35944608 DOI: 10.1016/j.gie.2022.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/15/2022] [Accepted: 07/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Despite advances in endoscopic therapies, malignancy-related GI bleeding remains difficult to manage with high rates of treatment failure and rebleeding. Topical hemostatic agents (THAs) are easier to apply to the wide bleeding surface of tumors. We conducted this systematic review and meta-analysis to evaluate the efficacy of THAs in malignancy-related GI bleeding. METHODS We conducted a comprehensive search of multiple electronic databases to identify studies reporting on the use of THAs in malignancy-related GI bleeding. The primary outcome was the achievement of hemostasis; secondary outcomes were early rebleeding (≤3 days), delayed rebleeding (>3 days), aggregate rebleeding, all-cause mortality, and GI bleeding-related mortality. A meta-analysis of proportions was done for all outcomes. RESULTS Out of 355 citations, 16 studies with 530 patients were included. Primary hemostasis was achieved in 94.1% (95% confidence interval [CI], 91.5-96.0). Early rebleeding was seen in 13.9% (95% CI, 9.7-19.4) and delayed rebleeding in 11.4% (95% CI, 5.8-21.1). Aggregate rebleeding was seen in 24.2% (95% CI, 18.5-31.0). All-cause mortality was 33.1% (95% CI, 23.7-44.0), whereas GI bleeding-related mortality occurred in 5.9% (95% CI, 2.2%-14.8). CONCLUSIONS THAs are highly effective for achieving primary hemostasis in malignancy-related GI bleeding. It should be considered as an alternative to traditional endotherapy methods in malignancy-related GI bleeding. Future studies should be designed to evaluate its efficacy and safety as a primary method of hemostasis as compared with traditional endotherapy measures.
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Affiliation(s)
- Rahul Karna
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Smit Deliwala
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan, USA
| | | | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, Utah, USA
| | - Lena Kassab
- Department of Internal Medicine, Mayo College of Medicine, Rochester, Minnesota, USA
| | - Aymeric Becq
- Endoscopy Unit, Sorbonne University, AP-HP, Saint-Antoine Hospital, Paris, France; Gastroenterology Department, UPEC University, AP-HP, Henri Mondor Hospital, Creteil, France
| | - Manish Dhawan
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, Colorado, USA
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6
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Hemostatic Powders in Non-Variceal Upper Gastrointestinal Bleeding: The Open Questions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010143. [PMID: 36676767 PMCID: PMC9863809 DOI: 10.3390/medicina59010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
Hemostatic powder (HP) is a relatively recent addition to the arsenal of hemostatic endoscopic procedures (HEPs) for gastrointestinal bleeding (GIB) due to benign and malignant lesions. Five types of HP are currently available: TC-325 (Hemospray™), EndoClot™, Ankaferd Blood Stopper®, and, more recently, UI-EWD (NexpowderTM) and CEGP-003 (CGBio™). HP acts as a mechanical barrier and/or promotes platelet activation and coagulation cascade. HP may be used in combination with or as rescue therapy in case of failure of conventional HEPs (CHEPs) and also as monotherapy in large, poorly accessible lesions with multiple bleeding sources. Although the literature on HP is abundant, randomized controlled trials are scant, and some questions remain open. While HP is highly effective in inducing immediate hemostasis in GIB, the rates of rebleeding reported in different studies are very variable, and conditions affecting the stability of hemostasis have not yet been fully elucidated. It is not established whether HP as monotherapy is appropriate in severe GIB, such as spurting peptic ulcers, or should be used only as rescue or adjunctive therapy. Finally, as it can be sprayed on large areas, HP could become the gold standard in malignancy-related GIB, which is often nonresponsive or not amenable to treatment with CHEPs as a result of multiple bleeding points and friable surfaces. This is a narrative review that provides an overview of currently available data and the open questions regarding the use of HP in the management of non-variceal upper GIB due to benign and malignant diseases.
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7
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Martins BC, Abnader Machado A, Scomparin RC, Paulo GA, Safatle-Ribeiro A, Naschold Geiger S, Lenz L, Lima MS, Pennacchi C, Ribeiro U, Barkun AN, Maluf-Filho F. TC-325 hemostatic powder in the management of upper gastrointestinal malignant bleeding: a randomized controlled trial. Endosc Int Open 2022; 10:E1350-E1357. [PMID: 36262517 PMCID: PMC9576337 DOI: 10.1055/a-1906-4769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background and study aims Upper gastrointestinal bleeding (UGIB) from malignancy is associated with high rebleeding and mortality rates. Recently, TC-325 powder has shown promising results in the treatment of UGIB, including malignant bleeding. The aim of this study was to compare the efficacy of TC-325 versus best clinical management. Patients and methods From August 2016 to February 2020, all patients with evidence of UGIB from malignancy were randomized to receive TC-325 therapy or control group, in which endoscopic treatment was not mandatory. Exclusion criteria were hemoglobin drop without overt bleeding and UGIB from non-tumor origin. The primary outcome was 30-day mortality. Secondary outcomes were 30-day rebleeding, blood transfusion and length of hospital stay. Results Sixty-two patients were randomized, three were excluded and 59 were included in the final analysis (TC-325 group = 28; control = 31). Groups were similar at baseline. Active bleeding was observed in 22 patients in the TC-325 group and 19 in the control group ( P = 0.15). Successful initial hemostasis with TC-325 was achieved in all cases. Additional therapy (radiotherapy, surgery or arterial embolization) was equally performed in both groups (42.9 % vs 58.1 %; P = 0.243). There were no differences in 30-day mortality (28.6 % vs. 19.4 %, P = 0.406) or 30-day rebleeding rates (32.1 % vs. 19.4 %, P = 0.26). Logistic regression identified no significant predictors of rebleeding. Age, Eastern Cooperative Oncology Group (ECOG) score 3 to 4 and AIMS65 score > 1 predicted greater mortality. Conclusions TC-325 was effective in achieving immediate hemostasis in malignant gastrointestinal bleeding but did not reduce 30-day mortality, 30-day rebleeding, blood transfusion or length of hospital stay. Age, ECOG 3-4, and AIMS65 > 1 were predictive factors of mortality.
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Affiliation(s)
- Bruno Costa Martins
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andressa Abnader Machado
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo Corsato Scomparin
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gustavo Andrade Paulo
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Adriana Safatle-Ribeiro
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sebastian Naschold Geiger
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luciano Lenz
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Simas Lima
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Caterina Pennacchi
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ulysses Ribeiro
- Department of Gastroenterology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alan N. Barkun
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada,Department of Clinical Epidemiology, McGill University, Montréal, Quebec, Canada
| | - Fauze Maluf-Filho
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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8
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Jiang SX, Chahal D, Ali-Mohamad N, Kastrup C, Donnellan F. Hemostatic powders for gastrointestinal bleeding: a review of old, new, and emerging agents in a rapidly advancing field. Endosc Int Open 2022; 10:E1136-E1146. [PMID: 36238531 PMCID: PMC9552790 DOI: 10.1055/a-1836-8962] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/20/2022] [Indexed: 10/26/2022] Open
Abstract
Background and study aims Hemostatic powders are increasingly used to address limitations in conventional endoscopic techniques for gastrointestinal bleeding. Various agents exist with different compositions, characteristics, efficacy, and adverse events (AEs). We sought to review existing hemostatic powders, from preclinical to established agents. Methods A literature review on hemostatic powders for gastrointestinal bleeding was undertaken through a MEDLINE search from 2000-2021 and hand searching of articles. Relevant literature was critically appraised and reviewed for mechanism of action, hemostasis and rebleeding rate, factors associated with hemostatic failure, and AEs. Results The most established agents are TC-325 (Hemospray), EndoClot, and Ankaferd Blood Stopper (ABS). These agents have been successfully applied to a variety of upper and lower gastrointestinal bleeding etiologies, in the form of primary, combination, salvage, and bridging therapy. Few AEs have been reported, including visceral perforation, venous embolism, and self-limited abdominal pain. Newer agents include CEGP-003 and UI-EWD, which have shown results similar to those for the older agents in initial clinical studies. All aforementioned powders have high immediate hemostasis rates, particularly in scenarios not amenable to conventional endoscopic methods, but are limited by significant rates of rebleeding. Other treatments include TDM-621 (PuraStat) consisting of a liquid hemostatic agent newly applied to endoscopy and self-propelling thrombin powder (CounterFlow Powder), a preclinical but promising agent. Conclusions Rapid development of hemostatic powders and growing clinical expertise has established these agents as a valuable strategy in gastrointestinal bleeding. Further research will continue to refine the efficacy and applicability of these agents.
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Affiliation(s)
- Shirley X. Jiang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daljeet Chahal
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | - Nabil Ali-Mohamad
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christian Kastrup
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada,Blood Research Institute, Versiti, Milwaukee, Wisconsin, United States
| | - Fergal Donnellan
- Division of Gastroenterology, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
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9
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Khorobrykh TV, Abdulkhakimov NM, Agadzhanov VG, Aghayan DL, Kazaryan AM. Laparoscopic versus open surgery for locally advanced and metastatic gastric cancer complicated with bleeding and/or stenosis: short- and long-term outcomes. World J Surg Oncol 2022; 20:216. [PMID: 35752852 PMCID: PMC9233806 DOI: 10.1186/s12957-022-02674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Laparoscopic surgery has justified its efficacy in the treatment of early gastric cancer. There are limited data indicating the eligibility of laparoscopic interventions in locally advanced gastric cancer. Publications describing the safety of laparoscopic techniques in the treatment of local and metastatic gastric cancer complicated by bleeding and stenosis are scarce. Methods The study included patients with histologically confirmed locally advanced and disseminated gastric cancer and complicated with bleeding and/or stenosis who underwent gastrectomy with vital indications between February 2012 and August 2018. Surgical and oncologic outcomes after laparoscopic surgery (laparoscopic surgery) and open surgery (OS) were compared. Results In total, 127 patients (LS, n = 52; OS, n = 75) were analyzed. Baseline characteristics were similar between the groups. Forty-four total gastrectomies with resection of the abdominal part of the esophagus, 63 distal subtotal (43 Billroth-I and 20 Billroth-II), and 19 proximal gastrectomies were performed. The median duration of surgery was significantly longer in the LS group, 253 min (interquartile range [IQR], 200–295) versus 210 min (IQR, 165–220) (p < 0.001), while median intraoperative blood loss in the LS group was significantly less, 180 ml (IQR, 146—214) versus 320 ml (IQR, 290–350), (p < 0.001). Early postoperative complications occurred in 35% in the LS group and in 45 % of patients in the OS group (p = 0.227). There was no difference in postoperative mortality rates between the groups (3 [6 %] versus 5 (7 %), p = 1.00). Median intensive care unit stay and median postoperative hospital stay were significantly shorter after laparoscopy, 2 (IQR, 1–2) versus 4 (IQR, 3–4) days, and 8 (IQR, 7–9) versus 10 (IQR, 8–12) days, both p < 0.001. After laparoscopy, patients started adjuvant chemotherapy significantly earlier than those after open surgery, 20 vs. 28 days (p < 0.001). However, overall survival rates were similar between the group. Three-year overall survival was 24% in the LS group and 27% in the OS groups. Conclusions Despite the technical complexity, in patients with complicated locally advanced and metastatic gastric cancer, laparoscopic gastrectomies were associated with longer operation time, reduced intraoperative blood loss, shorter reconvalescence, and similar morbidity, mortality rates and long-term oncologic outcomes compared to conventional open surgery.
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Affiliation(s)
- Tatyana V Khorobrykh
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Nuriddin M Abdulkhakimov
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vadim G Agadzhanov
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Davit L Aghayan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Airazat M Kazaryan
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia. .,The Intervention Centre, Oslo University Hospital, Oslo, Norway. .,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. .,Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway. .,Department of Surgery, Helse Fonna Hospital Trust, Odda, Norway. .,Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
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10
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Kawabata H, Fujii T, Yamamoto T, Satake H, Yamaguchi K, Okazaki Y, Nakase K, Miyata M, Motoi S. Palliative Radiotherapy for Bleeding from Unresectable Gastric Cancer Using Three-Dimensional Conformal Technique. Biomedicines 2022; 10:biomedicines10061394. [PMID: 35740415 PMCID: PMC9219767 DOI: 10.3390/biomedicines10061394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 12/24/2022] Open
Abstract
Optimal regimens using recent radiotherapy (RT) equipment for bleeding gastric cancer (GC) have not been fully investigated yet. We retrospectively reviewed the clinical data of 20 patients who received RT for bleeding GC in our institution between 2016 and 2021. Three-dimensional conformal RT was performed. The effectiveness of RT was evaluated by the mean serum hemoglobin (Hb) level and the number of transfused red blood cell (RBC) units 1 month before and after RT. The median first radiation dose was a BED of 39.9 Gy. The treatment success rate was 95% and the rebleeding rate was 10.5%. There was a significant increase in the mean Hb level (8.0 ± 1.1 vs. 9.8 ± 1.3 g/dL, p = 0.01), and a significant decrease in the mean number of transfused RBC units (6.8 ± 3.3 vs. 0.6 ± 1.5 units, p < 0.01). Severe toxicity was observed in two patients (anorexia [n = 1] and gastrointestinal [GI] perforation [n = 1]). Reirradiation was attempted in three patients (for hemostasis [n = 2] and for mass reduction [n = 1]). The retreatment success rate for rebleeding was 100%. GI perforation occurred in two patients who had received hemostatic reirradiation. Palliative RT for bleeding GC using recent technology had excellent efficacy. However, it may be associated with a risk of GI perforation.
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Affiliation(s)
- Hideaki Kawabata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
- Correspondence: ; Tel.: +81-774-48-5500
| | - Takashi Fujii
- Department of Radiology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan;
| | - Tetsuya Yamamoto
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Hiroaki Satake
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Katsutoshi Yamaguchi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Yuji Okazaki
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Kojiro Nakase
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Masatoshi Miyata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
| | - Shigehiro Motoi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Kyoto 6130034, Japan; (T.Y.); (H.S.); (K.Y.); (Y.O.); (K.N.); (M.M.); (S.M.)
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11
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Stilidi IS, Sigua BV, Zemlyanoy VP, Kurkov AA, Gubkov II. [Gastric cancer complicated by bleeding. (A systematic review)]. Khirurgiia (Mosk) 2022:102-115. [PMID: 35658142 DOI: 10.17116/hirurgia2022061102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bleeding as the most common complication of gastric cancer is a significant problem of modern surgery. Both oncologists and surgeons in ordinary hospitals deal with this adverse event. In addition to the well-known drugs for hemostasis, there are also generally recognized traditional methods of endoscopic hemostasis and transcatheter angiographic embolization. Surgical interventions do not lose their role too if previous hemostatic methods turned out to be ineffective. The reports devoted to radiotherapy for treatment and prevention of gastric bleeding following malignant process have been recently published. Such a wide choice of hemostatic methods prompted us to analyze the most significant recent studies regarding effectiveness of various methods and choice of the most optimal one.
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Affiliation(s)
- I S Stilidi
- Blokhin National Cancer Research Center, Moscow, Russia
| | - B V Sigua
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - V P Zemlyanoy
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A A Kurkov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - I I Gubkov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
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12
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Propensity score matching analysis to evaluate efficacy of polyethylene oxide adhesive on preventing delayed bleeding after gastric endoscopic submucosal dissection. Sci Rep 2022; 12:4538. [PMID: 35297400 PMCID: PMC8927376 DOI: 10.1038/s41598-022-08499-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/07/2022] [Indexed: 02/07/2023] Open
Abstract
Regardless of technical advancements, delayed bleeding is still a common adverse event after gastric endoscopic submucosal dissection (ESD), often occurring in the early postoperative phase. This study aimed to evaluate the efficacy of a newly designed polyethylene oxide (PEO) adhesive for preventing delayed gastric bleeding. Patients who underwent gastric ESD between December 2017 and December 2020 at three Chinese institutions were retrospectively reviewed. Patients receiving PEO application on gastric post-ESD ulcers were included in the PEO group, and patients without this procedure were included in the control group. To minimize potential bias, propensity score matching was performed, and sex, age, lesion size, lesion morphology, ulceration, localization, procedure time, frequency of major intraoperative bleeding, resected specimen size, lesion histopathology, submucosal invasion and the taking of antithrombotic drugs were included as matching factors. The incidence of delayed bleeding and time to bleeding were compared between both groups. After propensity score matching, 270 patients (135 per group) were included in the analysis. The delayed bleeding rate in the PEO group was significantly lower than that in the control group (1.5%, 2/135 vs. 8.9%, 12/135, P = 0.006). The median time (range) to bleeding was 4.5 (4–5) days in the PEO group and 2 (1–15) days in the control group, with no significant difference (P = 0. 198). PEO demonstrated a significant effect in reducing the rate of delayed bleeding. Further study is warranted to confirm the efficacy of PEO for bleeding that occurs in the early phase after gastric ESD.
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13
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Stilidi IS, Sigua BV, Zemlyanoy VP, Kurkov AA, Gubkov II. [Gastric cancer complicated by bleeding: a systematic review]. Khirurgiia (Mosk) 2022:101-114. [PMID: 35289556 DOI: 10.17116/hirurgia2022031101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bleeding as the most common complication of gastric cancer is a significant problem of modern surgery. Both oncologists and surgeons in ordinary hospitals deal with this adverse event. In addition to the well-known drugs for hemostasis, there are also generally recognized traditional methods of endoscopic hemostasis and transcatheter angiographic embolization. Surgical interventions do not lose their role too if previous hemostatic methods turned out to be ineffective. The reports devoted to radiotherapy for treatment and prevention of gastric bleeding following malignant process have been recently published. Such a wide choice of hemostatic methods prompted us to analyze the most significant recent studies regarding effectiveness of various methods and choice of the most optimal one.
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Affiliation(s)
- I S Stilidi
- Blokhin National Cancer Research Center, Moscow, Russia
| | - B V Sigua
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - V P Zemlyanoy
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A A Kurkov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - I I Gubkov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
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14
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Chen YI, Wyse J, Lu Y, Martel M, Barkun AN. TC-325 hemostatic powder versus current standard of care in managing malignant GI bleeding: a pilot randomized clinical trial. Gastrointest Endosc 2020; 91:321-328.e1. [PMID: 31437456 DOI: 10.1016/j.gie.2019.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS TC-325 (Hemospray; Cook Medical, Winston-Salem, NC, USA), an endoscopic hemostatic powder, exhibits possible benefits in patients with malignant GI bleeding. Our aim is to assess feasibility and determine estimates of efficacy of TC-325 compared with standard of care (SOC) in terms of initial hemostasis and recurrent bleeding rates in comparable groups of patients with malignant GI bleeding. METHODS Adult patients presenting with acute malignant upper or lower GI bleeding were randomized to TC-325 or SOC. Measured outcomes included feasibility of recruitment and randomization in the urgent care setting, immediate hemostasis, recurrent bleeding, need for additional treatment modalities, and mortality. RESULTS A preplanned 20 patients (upper GI source in 85%) were randomized 1:1 to TC-325 or SOC (25% women, age 67.2 ± 15.9 years, oozing in 95%) over 20 months. Immediate hemostasis was achieved in 90% of patients treated initially with TC-325 versus 40% in the SOC group (P = .057). Overall, 83.3% crossed over to TC-325, with hemostasis then achieved at index endoscopy in 80%. Overall, hemostasis at index endoscopy (before or after crossover) was obtained in 87.7% of patients treated with TC-325. Recurrent bleeding over the next 180 days was 20% in the TC-325 group compared with 60% in the SOC group (P = .170). CONCLUSIONS This pilot trial demonstrates the feasibility of TC-325 in malignant GI bleeding and provides results to help inform a larger randomized trial. Although not powered for such, results suggest that use of TC-325 is a very promising modality in malignant GI bleeding in achieving immediate hemostasis and may even result in decreased subsequent recurrent bleeding. (Clinical trial registration number: NCT02135627.).
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Affiliation(s)
- Yen-I Chen
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - Jonathan Wyse
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montréal, Quebec, Canada
| | - Yidan Lu
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - Myriam Martel
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada; Department of Clinical Epidemiology, McGill University Health Centre, McGill University, Montréal, Quebec, Canada
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15
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Lee DH, Ko W. Hemostatic materials in non-variceal upper gastrointestinal hemorrhage. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii190015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Don Haeng Lee
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
- Utah-Inha DDS and Advanced Therapeutics Research Center, Incheon, Korea
| | - Weonjin Ko
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
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16
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Naseer M, Lambert K, Hamed A, Ali E. Endoscopic advances in the management of non-variceal upper gastrointestinal bleeding: A review. World J Gastrointest Endosc 2020; 12:1-16. [PMID: 31942229 PMCID: PMC6939122 DOI: 10.4253/wjge.v12.i1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/28/2019] [Accepted: 10/19/2019] [Indexed: 02/06/2023] Open
Abstract
Upper gastrointestinal bleeding is defined as the bleeding originating from the esophagus to the ligament of Treitz and further classified into variceal and non-variceal gastrointestinal bleeding. Non-variceal upper gastrointestinal bleeding remains a common clinical problem globally. It is associated with high mortality, morbidity, and cost of the health care system. Despite the continuous improvement of therapeutic endoscopy, the 30-d readmission rate secondary to rebleeding and associated mortality is an ongoing issue. Available Food and Drug Administration approved traditional or conventional therapeutic endoscopic modalities includes epinephrine injection, argon plasma coagulation, heater probe, and placement of through the scope clip, which can be used alone or in combination to decrease the risk of rebleeding. Recently, more attention has been paid to the novel advanced endoscopic devices for primary treatment of the bleeding lesion and as a secondary measure when conventional therapies fail to achieve hemostasis. This review highlights emerging endoscopic modalities used in the management of non-variceal upper gastrointestinal related bleeding such as over-the-scope clip, Coagrasper, hemostatic sprays, radiofrequency ablation, cryotherapy, endoscopic suturing devices, and endoscopic ultrasound-guided angiotherapy. In this review article, we will also discuss the technical aspects of the common procedures, outcomes in terms of safety and efficacy, and their advantages and limitations in the setting of non-variceal upper gastrointestinal bleeding.
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Affiliation(s)
- Maliha Naseer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, East Carolina University, Greenville, NC 27834, United States
| | - Karissa Lambert
- Department of Internal Medicine, East Carolina University, Greenville, NC 27834, United States
| | - Ahmed Hamed
- Department of Internal Medicine, East Carolina University, Greenville, NC 27834, United States
| | - Eslam Ali
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, East Carolina University, Greenville, NC 27834, United States
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17
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Management of Bleeding from Unresectable Gastric Cancer. Biomedicines 2019; 7:biomedicines7030054. [PMID: 31344824 PMCID: PMC6784219 DOI: 10.3390/biomedicines7030054] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Bleeding from unresectable gastric cancer (URGC) is not a rare complication. Two major ways in which the management of this issue differs from the management of benign lesions are the high rate of rebleeding after successful hemostasis and that not only endoscopic therapy (ET) and transcatheter arterial embolization (TAE) but palliative radiotherapy (PRT) can be applied in the clinical setting. However, there are no specific guidelines concerning the management of URGC with bleeding. We herein discuss strategies for managing bleeding from URGC. A high rate of initial hemostasis for active bleeding is expected when using various ET modalities properly. If ET fails in patients with hemostatic instability, emergent TAE is considered in order to avoid a life-threating condition due to massive bleeding. Early PRT, especially, regimens with a high biologically effective dose (BED) of ≥39 Gy should be considered not only for patients with hemostatic failure but also for those with successful hemostasis and inactive hemorrhage, as longer duration of response with few complications can be expected. Further prospective, comparative studies considering not only the hemostatic efficacy of these modalities but the patients' quality of life are needed in order to establish treatment strategies for bleeding from URGC.
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18
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Baracat FI, de Moura DTH, Brunaldi VO, Tranquillini CV, Baracat R, Sakai P, de Moura EGH. Randomized controlled trial of hemostatic powder versus endoscopic clipping for non-variceal upper gastrointestinal bleeding. Surg Endosc 2019; 34:317-324. [PMID: 30927124 DOI: 10.1007/s00464-019-06769-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/18/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Despite advances in pharmacological and endoscopic management of non-variceal upper gastrointestinal bleeding (NVUGIB), mortality is still relevant. TC-325 (Hemospray-Cook Medical) is a mineral powder with adsorptive properties, designed for endoscopic hemostasis. There are still no comparative trials studying this new hemostatic modality. The objective of this research was to compare the use of TC-325 (associated with epinephrine injection) with the combined technique of endoscopic clipping and epinephrine injection for the treatment of patients with NVUGIB. METHODS We conducted a pilot randomized controlled trial with patients that presented NVUGIB with an actively bleeding lesion at the endoscopic evaluation. Patients were randomized either to the Hemospray or Hemoclip group. The randomization list was generated by a computer program and remained unknown throughout the entire trial. All patients underwent second-look endoscopy. RESULTS Thirty-nine patients were enrolled. Peptic ulcer was the most frequent etiology. Primary hemostasis was achieved in all Hemospray cases and in 90% of Hemoclip group (p = 0.487). Five patients in Hemospray group underwent an additional hemostatic procedure during second-look endoscopy, while no patient in the Hemoclip group needed it (p = 0.04). Rebleeding, emergency surgery and mortality rates were similar in both groups. No toxicity, allergy events, or gastrointestinal obstruction signs were observed in Hemospray group. CONCLUSIONS TC-325 presents similar hemostatic results when compared with conventional dual therapy for patients with NVUGIB. Hemospray's excellent primary hemostasis rate certifies it as a valuable tool in arduous situations of severe bleeding or difficult location site.
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Affiliation(s)
- Felipe Iankelevich Baracat
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César, São Paulo, 05403-000, Brazil.
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César, São Paulo, 05403-000, Brazil
| | - Vítor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César, São Paulo, 05403-000, Brazil
| | - Caio Vinicius Tranquillini
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César, São Paulo, 05403-000, Brazil
| | - Renato Baracat
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César, São Paulo, 05403-000, Brazil
| | - Paulo Sakai
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César, São Paulo, 05403-000, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César, São Paulo, 05403-000, Brazil
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