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Role of hemoclips in the management of acute bleeding from a gastric stromal tumor: a case report and review of the literature.

Khashab MA, Cramer HM, Liangpunsakul S - J Med Case Rep (2007)

Bottom Line: We report a case of gastric GIST in an elderly patient who presented with bleeding.Homeostasis was achieved initially with the endoscopic placement of a hemoclip followed by treatment with the tyrosine kinase inhibitor, imatinib.The management of bleeding GISTs in the elderly pose a challenging task to the gastroenterologist and treatment strategies should be tailored to the expertise of the endoscopist, surgeon and other supportive staff.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Department of Medicine and Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. mkhashab@iupui.edu.

ABSTRACT

Introduction: Though gastrointestinal stromal tumors (GISTs) frequently present with gastrointestinal bleeding, the guidelines for the management and control of bleeding are unclear especially in patients who are not appropriate for surgical resection.

Case presentation: We report a case of gastric GIST in an elderly patient who presented with bleeding. Homeostasis was achieved initially with the endoscopic placement of a hemoclip followed by treatment with the tyrosine kinase inhibitor, imatinib.

Conclusion: The management of bleeding GISTs in the elderly pose a challenging task to the gastroenterologist and treatment strategies should be tailored to the expertise of the endoscopist, surgeon and other supportive staff.

No MeSH data available.


Related in: MedlinePlus

EGD showed the gastric mass with deep ulceration and bleeding visible vessels.
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Figure 1: EGD showed the gastric mass with deep ulceration and bleeding visible vessels.

Mentions: An 84-year-old man had an incidental finding of a stomach mass on an abdominal CT scan performed in preparation for an inguinal hernia repair. Esophagogastroduodenoscopy (EGD) was performed and showed a gastric deformity suggestive of a subepithelial tumor rather than extrinsic compression. Endoscopic ultrasound (EUS) showed an intramural (subepithelial) lesion in the greater curvature of the stomach, 3 cm distal to the gastroesophageal junction measuring 44 mm × 59 mm. EUS-guided fine needle aspiration was performed and cytological examination showed spindle shaped cells that stained positive for c-kit. The cytomorphological and immunocytological findings were suggestive of a diagnosis of gastrointestinal stromal tumor (GIST). Shortly after the diagnosis, the patient presented to our emergency department with a one week history of epigastric pain, melena and dizziness. Upon examination, his temperature was 37.4°C, pulse 72 beats/min, respirations 18 times/min, and blood pressure 164/78 while lying down and 105/71 while standing. The patient was alert and oriented. Laboratory tests revealed the following values: hemoglobin 10.6 g/dl (normal 12–15) and hematocrit 31.5% (normal 35–49). His basic metabolic profile, coagulation profile and liver function tests were all normal. He was resuscitated with intravenous fluids and transfused with two units of packed red blood cells. Repeat EGD showed the GIST tumor with deep ulceration and visible bleeding vessels (Figure 1). Homeostasis was achieved with placement of two hemoclips (Figure 2). The patient was evaluated by the general surgery team and deemed not a good surgical candidate due to his age and severe coronary artery disease. He was started on imatinib (Gleevec; Novartis Pharmaceuticals Corporation, East Hanover, NJ) 400 mg daily by mouth in accordance with oncology recommendations. Patient was discharged home with no further gastrointestinal bleeding. Upon follow up five months later, the patient was continuing to do well with no further episodes of gastrointestinal bleeding. His follow up hemoglobin was 13.4 g/dL and hematocrit 39%. Repeat upper endoscopy showed significant reduction in the size of the tumor. The previously identified ulcers were completely healed (Figure 3, arrow head).


Role of hemoclips in the management of acute bleeding from a gastric stromal tumor: a case report and review of the literature.

Khashab MA, Cramer HM, Liangpunsakul S - J Med Case Rep (2007)

EGD showed the gastric mass with deep ulceration and bleeding visible vessels.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2194709&req=5

Figure 1: EGD showed the gastric mass with deep ulceration and bleeding visible vessels.
Mentions: An 84-year-old man had an incidental finding of a stomach mass on an abdominal CT scan performed in preparation for an inguinal hernia repair. Esophagogastroduodenoscopy (EGD) was performed and showed a gastric deformity suggestive of a subepithelial tumor rather than extrinsic compression. Endoscopic ultrasound (EUS) showed an intramural (subepithelial) lesion in the greater curvature of the stomach, 3 cm distal to the gastroesophageal junction measuring 44 mm × 59 mm. EUS-guided fine needle aspiration was performed and cytological examination showed spindle shaped cells that stained positive for c-kit. The cytomorphological and immunocytological findings were suggestive of a diagnosis of gastrointestinal stromal tumor (GIST). Shortly after the diagnosis, the patient presented to our emergency department with a one week history of epigastric pain, melena and dizziness. Upon examination, his temperature was 37.4°C, pulse 72 beats/min, respirations 18 times/min, and blood pressure 164/78 while lying down and 105/71 while standing. The patient was alert and oriented. Laboratory tests revealed the following values: hemoglobin 10.6 g/dl (normal 12–15) and hematocrit 31.5% (normal 35–49). His basic metabolic profile, coagulation profile and liver function tests were all normal. He was resuscitated with intravenous fluids and transfused with two units of packed red blood cells. Repeat EGD showed the GIST tumor with deep ulceration and visible bleeding vessels (Figure 1). Homeostasis was achieved with placement of two hemoclips (Figure 2). The patient was evaluated by the general surgery team and deemed not a good surgical candidate due to his age and severe coronary artery disease. He was started on imatinib (Gleevec; Novartis Pharmaceuticals Corporation, East Hanover, NJ) 400 mg daily by mouth in accordance with oncology recommendations. Patient was discharged home with no further gastrointestinal bleeding. Upon follow up five months later, the patient was continuing to do well with no further episodes of gastrointestinal bleeding. His follow up hemoglobin was 13.4 g/dL and hematocrit 39%. Repeat upper endoscopy showed significant reduction in the size of the tumor. The previously identified ulcers were completely healed (Figure 3, arrow head).

Bottom Line: We report a case of gastric GIST in an elderly patient who presented with bleeding.Homeostasis was achieved initially with the endoscopic placement of a hemoclip followed by treatment with the tyrosine kinase inhibitor, imatinib.The management of bleeding GISTs in the elderly pose a challenging task to the gastroenterologist and treatment strategies should be tailored to the expertise of the endoscopist, surgeon and other supportive staff.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Department of Medicine and Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. mkhashab@iupui.edu.

ABSTRACT

Introduction: Though gastrointestinal stromal tumors (GISTs) frequently present with gastrointestinal bleeding, the guidelines for the management and control of bleeding are unclear especially in patients who are not appropriate for surgical resection.

Case presentation: We report a case of gastric GIST in an elderly patient who presented with bleeding. Homeostasis was achieved initially with the endoscopic placement of a hemoclip followed by treatment with the tyrosine kinase inhibitor, imatinib.

Conclusion: The management of bleeding GISTs in the elderly pose a challenging task to the gastroenterologist and treatment strategies should be tailored to the expertise of the endoscopist, surgeon and other supportive staff.

No MeSH data available.


Related in: MedlinePlus