Upper gastrointestinal bleeding is a common emergency and one of the most common complications of gastric cancer. Upper gastrointestinal bleeding usually has an acute onset and seriously affects the outcome and life of patients. This article describes the causes and management of upper gastrointestinal bleeding in patients with gastric cancer.
Why does upper gastrointestinal bleeding occur in gastric cancer?
There are many reasons why bleeding occurs in patients with gastric cancer, including the following:
- Rapid tumor growth and relatively inadequate blood supply, leading to the formation of ulcers and erosions in the center of the tumor;
- Tumor erosion of larger blood vessels in the stomach wall or formation of ulcers involving important blood vessels of the stomach, resulting in massive bleeding;
- A few early lesions invade the vascular plexus under the mucosa;
- Because most patients with gastric cancer are middle-aged and elderly, there are varying degrees of arteriosclerosis and reduced vasoconstriction, which makes bleeding easy to occur;
- When patients with gastric cancer have larger cancer foci necrosis rapidly invading larger blood vessels or more neovascularization, it can cause hemorrhage, which is the main cause of combined hemorrhage in gastric cancer. It is manifested as vomiting coffee-like material, tarry stools, and in a few patients, large vomiting of blood.
How to manage upper gastrointestinal bleeding when it occurs?
Because the underlying cause of bleeding is gastric cancer, the most fundamental treatment is directed at the treatment of gastric cancer. Currently, gastric cancer is treated mainly with a combination of treatments, including preoperative neoadjuvant therapy, surgery, and postoperative adjuvant therapy, with surgery still being the primary treatment for gastric cancer. For the manifestation of bleeding, doctors will also mainly take the following methods to deal with it.
- For upper gastrointestinal bleeding, doctors usually choose endoscopic treatment. Under gastroscopy, doctors can directly observe the bleeding site and bleeding situation and use various means such as spraying hemostatic drugs, local submucosal injection, electrocoagulation to stop bleeding or titanium clips to stop bleeding depending on the condition. Specifically, the injected drugs may be epinephrine, thrombin, fibrin glue, etc.
- For refractory bleeding, acute bleeding, the doctor may choose to treat it with interventional catheter embolization. First, the doctor will puncture the femoral artery at the root of the thigh, place a catheter into it for imaging to find the site of bleeding, and then place a spring coil or inject embolic agent (possibly with injection of gelatin sponge) into the bleeding site via the catheter at the puncture site. If the imaging does not reveal a clear site of bleeding, the doctor may perform empirical embolization based on clinical presentation, gastroscopy, etc. In some patients, the punctured catheter is retained for 1 day after the procedure until it is removed if the bleeding does not recur. This approach has the advantage of being safe and effective in the treatment of gastric cancer-associated gastrointestinal bleeding.
- Pharmacologic therapy is a conservative treatment for patients who develop upper gastrointestinal bleeding, and with the exclusion of critical conditions such as arterial hemorrhage, conventional therapy may be considered by physicians along with pharmacologic therapy, which is usually well tolerated by patients and whose hemostatic effect is gradually improving. Commonly used hemostatic drugs include posterior pituitary hormone, omeprazole, and octreotide.
- Patients whose condition remains unstable or inconvenient for gastroscopy after these initial treatments are usually considered by the surgeon for an emergency surgical dissection, while surgical removal of the lesion is sought.
Upper gastrointestinal bleeding is usually rapid, fast-moving, and can be life-threatening in severe cases. Early detection of bleeding can help with early management, and patients should seek medical help when they notice abnormalities in vomit or stool.