Clinical outcomes of upper gastrointestinal bleeding in gastric and duodenal gastrointestinal stromal tumor

Background and aims: There were not enough studies about bleeding in gastric and duodenal gastrointestinal stromal tumor (GIST). Therefore, we tried to analyze the characteristics and clinical outcomes of patients in gastric and duodenal GIST with bleeding compare to without bleeding. Patients and methods: Between January 1998 to May 2015, 861 patients were diagnosed as primary gastric or duodenal GIST at Our Center. Of total, 78 patients had bleeding (9.1%) and we investigated clinical outcomes and compared results between bleeding group and non-bleeding group.Results: Among 78 patient with bleeding, endoscopic treatment, transarterial embolization, or surgical management were performed for initial hemostasis in 31 (39.7%), 7 (9.0%), and 2 (2.6%), respectively, and others were managed conservatively. In patients with endoscopic or radiologic intervention (n=38), additional intervention were required in 6 patients (15.8%) due to rebleeding. During median 30 months (interquartile range 30-98 months) of follow-up periods, 24 patients were died in bleeding group and 89 patients in non-bleeding group, and the 5-year survival rate 70.9% in bleeding group and 91.9% in non-bleeding group (p<0.001). Multivariate analysis showed that duodenal GIST, the maximal diameter greater than 5cm, and necrosis finding were significant risk factors for bleeding in gastric and duodenal GIST.Conclusions: Prompt removal should be considered before bleeding happens, especially when GIST is located on the duodenum, large than 5cm, and shows necrotic portion.