Background and Aims
Endoscopic hemostatic techniques remain poorly effective for GI tumor bleeding. We
assessed Tc-325 (Hemospray, Cook Medical, Bloomington, Ind, USA) for this indication
and determined possible predictors of decreased recurrent bleeding and improved 6-month
survival in affected patients.
Methods
This retrospective study identified 99 patients with active malignant GI bleeding
(primary or metastatic) treated with Tc-325. Eleven patients were excluded because
of incomplete data. Data on patient characteristics and possible predictive factors
of early (72-hour) and delayed (7-, 14-, and 30-day) recurrent bleeding, as well as
6-month survival, were collected.
Results
Overall, 70.5% were male (age, 65 ± 14 years). Half had a high Eastern Cooperative
Oncology Group (ECOG) score (3 or 4). An upper GI cancer was found in 56.8%, and 72.7%
cancers were stage 4. Of those affected, 51.6% received at least 1 non-endoscopic
additional definitive hemostatic treatment after Tc-325. Immediate hemostasis with
Tc-325 was 97.7%, with recurrent bleeding noted in 15% (early) and 17% (delayed).
Six-month survival was 53.4%. On multivariable analysis, no predictive factor for
recurrent bleeding was identified, whereas ECOG score 0 to 2 (P = .001; hazard ratio [HR], 0.14; 95% confidence interval [CI], 0.04-0.47), cancer
stage 1 to 3 (P = .04; HR, 0.31; 95% CI, 0.10-0.96), and receiving definite hemostatic treatment
alone or in any combination with surgery, chemotherapy, radiotherapy, or radiologic
embolization (P = .002; HR, 0.24; 95% CI, 0.09-0.59) were significant prognosticators of 6-month
survival after adjusting for comorbidity, type of cancer bleeding, and presence of
a coagulopathy.
Conclusion
Before definitive therapy can be offered, Tc-325 provides effective initial hemostasis
of tumoral GI bleeding. Good performance status, non-end-stage cancer, and receiving
definite hemostatic treatment are independent predictors of 6-month survival. (Clinical
trial registration number: NCT03066700.)
Abbreviations:
CI (confidence interval), ECOG (Eastern Cooperative Oncology Group), HR (hazard ratio), INR (international normalized ratio), OR (odds ratio)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 20, 2017
Accepted:
November 9,
2017
Received:
September 12,
2017
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
