Role of Argon Plasma Coagulation in Management of Bleeding GI Tumors: Evaluating Outcomes and Survival

Abstract

Purpose: Tumor related GI bleeding (GIB) is a common and challenging clinical problem in patients with cancer. Argon plasma coagulation (APC) is one of the endoscopic hemostatic methods preferred for the management of nonneoplastic causes of GIB. However limited information is available on its role in management of bleeding GI tumors. The aim of this study was to assess the role of APC in the management of bleeding GI tumors. Methods: We performed a retrospective review of all endoscopies done at the UT MD Anderson Cancer Center over 3 consecutive years (2009-2011) and identified cases of tumor related gastrointestinal bleeding treated by APC. We collected data regarding demographics, cancer diagnosis and treatment, routine laboratory tests, outcomes of APC treatment, complications, and overall survival. Results: Argon plasma coagulation (APC) was performed on 10 patients with a median age of 58 (20-67) years. Majority of the patients were Caucasians (90%) and were male (80%). The diagnoses included 3 (30%) cases of esophageal cancer, 2 (20%) cases of colorectal cancer, and 1 (10%) case of each, gastric adenocarcinoma, gastrointestinal stromal tumor, renal cell cancer, multiple myeloma and large B cell lymphoma. Four patients presented with hematemesis (40%), four had melena (40%) and two presented with hematochezia (20%). Metastatic disease was present in all (100%) patients, with intraabdominal metastasis in 90% and intrathoracic metastasis in 60% of patients. APC was performed either alone (7 patients) or with adjuvant epinephrine (3 patients). Immediate hemostasis was achieved was in all 10 (100%) patients. None of the patients developed any procedure related complications. Four patients (40%) required blood transfusion within 48 hours of the procedure. Re-bleeding happened in 3 (30%) patients during follow up. at 48 hours, at 72 hours and at 1 year in 1 patient each. One patient was managed by conservative treatment with blood transfusion only; while 2 patients underwent intervention radiology guided embolization therapies. Median time between procedure to discharge was 5 (Range: 1-106) days. 30 day mortality rate was 0%. Mortality occurred in 8 (80%) patients over a mean follow-up of 262 (range: 46-805) days. The median time to mortality was 131 (95% CI: 59-176) days. Total of 7 (70%) of patients were able to continue cancer specific therapy including chemotherapy, radiation or both. Conclusion: In our experience, APC is feasible and safe in routine practice to manage bleeding GI tumors with procedure related complication rate of 0%. It is very effective in achieving initial hemostasis (100%) and allows majority of the patients (70%) to undergo cancer specific therapy.