Abstract
IntroductionEndoscopic hemostasis for severe upper gastrointestinal bleeding due to tumors, such as gastrointestinal stromal tumors and malignant lymphoma, is temporarily effective. However, permanent hemostasis is difficult in many cases because of diffuse bleeding.Case presentationA 60-year-old Japanese woman was admitted to our hospital with hematemesis. Endoscopy revealed multiple gastric polyps and fresh blood in her stomach. One of the gastric polyps, which was associated with oozing bleeding, was found near the anterior wall of the lower gastric body. We initially applied hemostatic forceps and argon plasma coagulation over the tumor surface, but the bleeding persisted. After endoscopic mucosal resection, exposed vessels were seen at the base of the mucosal resection site with oozing bleeding. Coagulation of the bleeding vessels using hemostatic forceps allowed successful completion of the hemostatic procedure. Our patient also had eight synchronous gastric cancer lesions. Histological examination of the resected specimens showed various types of cancer.ConclusionThis is a case report of gastric cancer associated with eight gastric cancer lesions, confirmed by histology, in which hemostasis was achieved through endoscopy.
Highlights
Endoscopic hemostasis for severe upper gastrointestinal bleeding due to tumors, such as gastrointestinal stromal tumors and malignant lymphoma, is temporarily effective
Permanent hemostasis is difficult in many cases because of diffuse bleeding [2]
We here report a case of endoscopic hemostasis with endoscopic mucosal resection (EMR) as a rescue therapy for bleeding of a malignant GI tumor after failed conventional therapy
Summary
Endoscopic hemostasis for severe upper gastrointestinal (GI) bleeding due to tumors, such as GI stromal tumors and malignant lymphoma, is temporarily effective [1]. We here report a case of endoscopic hemostasis with endoscopic mucosal resection (EMR) as a rescue therapy for bleeding of a malignant GI tumor after failed conventional therapy. This patient had multiple synchronous gastric cancers. Mucosal oozing continued after failed APC and the application of the hemostatic forceps (Figure 1) Bleeding of this polyp lesion persisted, and we did not determine whether it was a benign or a malignant tumor (in particular, hyperplastic poly or early gastric cancer). Histological examination showed various types of cancer (Figure 5a-c): well-differentiated, moderately-differentiated, and poorly-differentiated adenocarcinoma and signet-ring cell carcinoma that had developed independently in the mucosal and submucosal layers of the resected specimen. Our patient’s symptoms resolved after surgery, and she remained asymptomatic at the follow-up one-and-a-half years later
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