Acute Upper Gastrointestinal Bleeding is Associated With Poor Prognosis in Patients With Biliary Tract Cancer

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AIM: Upper gastrointestinal bleeding (UGIB) is associated with an unfavorable outcome in cancer patients. In patients with biliary tract cancer (BTC), data on the incidence, management, and prognostic implications of UGIB are limited. This study investigated the prevalence, treatment efficacy, and prognostic factors associated with UGIB in BTC. METHODS: This retrospective observational study included all patients with BTC and UGIB, treated at a tertiary care center between 2010 and 2023. Clinical, laboratory, endoscopic, and survival data were obtained from hospital records. Outcomes included short-term rebleeding within 14 days and overall survival. RESULTS: Among 1033 BTC patients, 37 (3.6%) experienced UGIB. The predominant etiologies were tumor-associated bleeding due to tumor infiltration (27.0%), variceal bleeding (21.6%), and ulcer bleeding (16.2%). Endoscopic therapy was performed in 43.2% of cases, achieving hemostasis in 78.6% of actively bleeding patients. Short-term rebleeding occurred in 28.6%. The 30-day mortality following UGIB was 35.7%. Tumor-associated UGIB correlated with significantly increased mortality (HR = 2.83, 95% CI 1.1-7.27, p = 0.030) and markedly reduced overall survival (28 vs. 90 days, p = 0.022). CONCLUSIONS: UGIB is a rare but severe complication in BTC. Tumor-associated UGIB was associated with poor prognosis and markedly shortened survival, underscoring the necessity for careful clinical assessment and close follow-up in this high-risk cohort.

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