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Management of Bleeding from Unresectable Gastric Cancer

Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, 100 Nishinokuchi, Sayama, Kumiyama-cho, Kuze-gun, Kyoto 613-0034, Japan
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Biomedicines 2019, 7(3), 54; https://doi.org/10.3390/biomedicines7030054
Received: 29 May 2019 / Revised: 15 July 2019 / Accepted: 19 July 2019 / Published: 24 July 2019
(This article belongs to the Special Issue Gastric Cancer Research: From Basic Science to the Clinic)
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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. View Full-Text
Keywords: gastric cancer; bleeding; endoscopy; transcatheter arterial embolization; palliative radiotherapy gastric cancer; bleeding; endoscopy; transcatheter arterial embolization; palliative radiotherapy
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Kawabata, H.; Hitomi, M.; Motoi, S. Management of Bleeding from Unresectable Gastric Cancer. Biomedicines 2019, 7, 54.

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