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Prognostic factors affecting outcomes in patients with malignant GI bleeding treated with a novel endoscopically delivered hemostatic powder

  • Rapat Pittayanon
    Affiliations
    Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital of the Thai Red Cross, Bangkok, Thailand

    Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Canada
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  • Rungsun Rerknimitr
    Affiliations
    Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital of the Thai Red Cross, Bangkok, Thailand
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  • Alan Barkun
    Correspondence
    Reprint requests: Alan Barkun, MD, Division of Gastroenterology, McGill University Health Centre, Montreal, Canada, PQ H3G 1A4.
    Affiliations
    Division of Gastroenterology, McGill University and the McGill University Health Centre, Montreal, Canada
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Published:November 20, 2017DOI:https://doi.org/10.1016/j.gie.2017.11.013

      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)
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