B0308 - Overt Gastrointestinal Bleeding in Patients With Cancer: Clinical Characteristics and Outcomes

Najlaa Hamadeh, MD¹, Anthony Kerbage, MD¹, Jana Al Hashash, MD¹, Don Rockey, MD², Kassem Barada, MD^1
1American University of Beirut, Beirut, Beyrouth, Lebanon; ²Digestive Disease Research Center, Medical University of South Carolina, Charleston, SC

Introduction: Characteristics and outcomes of patients with overt gastrointestinal bleeding (GIB) and known cancer are not well characterized. This study compared clinical characteristics, severity and outcomes of GIB between cancer patients (CP) and non-cancer patients (NCP).

Methods: This prospective study included patients admitted with overt GIB between 2013 and 2021. Clinical presentation, management, GIB etiology, need for endoscopy, and outcomes including rebleeding, mortality, and length of hospital stay, were compared between CP (active or inactive cancer) and NCP. Among CP, hematological malignancies were compared to solid tumors and then luminal to non-luminal cancers. The associations with categorical variables were assessed with the Chi-square test, and the t-test was used for continuous variables.

Results: Of 674 patients admitted for GIB, 144 had cancer. Among CP, 84% had active disease (diagnosed within 5 years of the GIB event or on cancer treatment), 49% had stage 4 disease on presentation, and 78% had solid tumors, of whom 20% had luminal GI cancers. Patients were followed for a median of 56 months. Compared to NCP, CP had higher Age-Adjusted Charlson Comorbidity Index, and were less likely to undergo endoscopy or endoscopic therapy. Severe GIB (SBP < 100mmHg, >2units of blood transfused, or ≥2g/dL drop in hemoglobin) was equally prevalent in both groups, but CP were more likely to receive transfusion (68 vs 54%, p=0.002). Peptic ulcer was the most common etiology of GIB in both groups (Table). 9 CP had non-GI cancers causing GIB due to metastasis to the GI tract or due to local invasion. 59% of CP with luminal GI cancers bled due to their cancers. There was no difference in the severity of GIB between luminal cancers and non-luminal cancers. Having cancer was associated with higher in-hospital (12 vs 6%; p=0.018), one-month (17 vs 5.2%; p< 0.001), one-year (48 vs 16%; p< 0.001), and end of follow-up mortality (72 vs 39%; p< 0.001). CP more frequently died of sepsis (16 vs 9%; p=0.02), uncontrolled GIB (4 vs 1%; p=0.026), and systemic malignancy (27 vs 0%, p< 0.001). Length of hospital stay and rebleeding rates did not differ between the two groups.

Discussion: CP with GIB are less likely to have diagnostic and therapeutic endoscopy and more likely to receive transfusion than NCP. They also have high short-term and long-term mortality. Steps to identify CP at risk for GIB and to improve their outcomes merit consideration and further investigation.



Disclosures:


Najlaa Hamadeh, MD¹, Anthony Kerbage, MD¹, Jana Al Hashash, MD¹, Don Rockey, MD², Kassem Barada, MD¹. B0308 - Overt Gastrointestinal Bleeding in Patients With Cancer: Clinical Characteristics and Outcomes, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.