Management of bleeding GI tumors

Bleeding GI tumors do not respond as readily to endoscopic treatment as many benign causes of bleeding. Thermal modalities may temporize bleeding, but hemorrhage often recurs and mortality is unchanged. Mechanical endoscopic therapies for bleeding tumors such as endoscopic clips are intuitively appealing and used frequently in our practice. For bleeding inaccessible to the endoscope or refractory to endoscopic interventions, angiography ideally with superselective embolization of the culprit vessel is recommended, but, as with endoscopic therapies, bleeding ceases only transiently in many cases. RT for bleeding does not work immediately but may be effective for subacute blood loss. Surgery for acutely bleeding GI tumors, particularly in patients with advanced disease, carries high morbidity and mortality rates and should be undertaken only as a last resort. Patients with bleeding tumors are best served by a multidisciplinary treatment team comprising gastroenterologists, surgeons, interventional radiologists, and radiation oncologists. In contrast to bleeding from a tumor, bleeding from radiation-induced bowel injury is readily treated with thermal modalities such as APC.