Prognostic factors affecting outcomes in patients with malignant GI bleeding treated with a novel endoscopically delivered hemostatic powder. Pittayanon R, Rerknimitr R, Barkun A. Gastrointest Endosc. 2017 Nov 17. [Epub ahead of print]

BACKGROUND AND AIM:Endoscopic hemostatic techniques remain poorly effective for GI tumor bleeding. We assessed Tc-325 (Hemospray) 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 six-month survival, were collected.RESULTS:Overall 70.5% were male (age 65 ± 14 years). Half had a high ECOG score (3 or 4). An upper GI cancer was found in 56.8%, whereas 72.7% cancers were stage 4. Of those affected, 51.6% received at least 1 nonendoscopic 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 0-2 (p=0.001; HR, 0.14; 95% CI, 0.04-0.47), cancer stage 1-3 (p=0.04; HR, 0.31; 95% CI, 0.10-0.96) and receiving definite hemostastic treatment alone or in any combination with surgery, chemotherapy, radiotherapy, or radiological embolization (p=0.002; 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.

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