The purpose of this study was to describe the causes and treatments of non-postoperative gastrointestinal
bleeding in patients with pancreatic ductal
adenocarcinoma, and explore the parameters associated with therapeutic effectiveness.
METHODS: This was a single-centre observational retrospective study (2000-2017) with data collected from the prospectively coded diagnostic hospital's database system including patients with pancreatic ductal
adenocarcinoma who had a gastrointestinal
bleeding episode. Effectiveness of haemostatic treatment was assessed according to transfusion requirements and immediate and long-term haemostatic efficacy; the latter defined as no
bleeding recurrence.
RESULTS: The population included 72 patients with pancreatic ductal
adenocarcinoma who had 94 episodes of gastrointestinal
bleeding. The main causes of gastrointestinal
bleeding were gastroduodenal tumour invasion (56.4%) and oesophageal variceal
bleeding due to
left-sided portal hypertension (19.1%). In cases of gastrointestinal
bleeding caused by tumour invasion, the main treatment was therapeutic endoscopy (41.5%). Among patients who had gastrointestinal
bleeding by tumour invasion treated by endoscopy or
radiation therapy, haemostatic immediate efficacy rates were 70.6% and 100%, respectively.
Bleeding recurrence rates were 35.3% and 25.0%, for patients treated by endoscopy or
radiation therapy, respectively, for a first episode of gastrointestinal
bleeding by tumour invasion. Transfusion requirements, before and
after treatment, were not different in patients treated by haemostatic
radiation therapy for gastrointestinal
bleeding by tumour invasion compared to other treatments (odds ratio 0.3, 95% CI (0.06-1.59); p = 0.16). The median survival after all-cause gastrointestinal
bleeding was 2.72 months (1.43-4.01).
CONCLUSION: Gastroduodenal tumour invasion was the main cause of gastrointestinal
bleeding in patients with pancreatic ductal
adenocarcinoma; haemostatic
radiation therapy is a potential interesting option for gastrointestinal
bleeding treatment in this context.