# Endoscopic Hemostasis for Gastrointestinal Stromal Tumor Hemorrhage: A Case Series and Retrospective Analysis of Risk Factors

## TL;DR

This study shows that endoscopic hemostasis can prevent emergency surgery for bleeding gastrointestinal stromal tumors and identifies ulceration as a risk factor for hemorrhage.

## Contribution

The study demonstrates the effectiveness of endoscopic hemostasis for GIST-related bleeding and identifies novel risk factors for hemorrhage.

## Key findings

- Endoscopic hemostasis successfully avoided emergency surgery in five GIST patients.
- Ulcer formation was a strong risk factor for GIST-related hemorrhage.
- Elevated white blood cell count and BMI were also associated with increased hemorrhage risk.

## Abstract

Gastrointestinal stromal tumors (GISTs) are vascular tumors that can cause significant gastrointestinal hemorrhage. While endoscopic treatment is common for other hemorrhagic disorders, its role in GIST‐related hemorrhage remains unclear. This study presents a case series of five patients who underwent successful endoscopic hemostasis for upper gastrointestinal GISTs and explores potential risk factors for hemorrhage.

This single‐center retrospective study included patients diagnosed with upper gastrointestinal GISTs between January 2013 and December 2022. Of the 61 eligible patients, the clinical courses of five patients who underwent endoscopic hemostasis were reviewed. In addition, an exploratory analysis was conducted to identify risk factors associated with GIST‐related hemorrhage by comparing hemorrhagic and non‐hemorrhagic groups using univariate analyses.

Five patients underwent successful endoscopic hemostasis using hypertonic saline‐epinephrine injection and/or clipping for hemorrhage from exposed vessels at the ulcer. Consequently, emergency surgery within 24 h was avoided in all cases, and elective surgery was conducted between 7 and 51 days. Additionally, ulcer formation (odds ratio [OR] 37.20; 95% confidence interval [CI] 2.40–582.00; p < 0.01), elevated white blood cell count (OR 1.05; 95% CI 1.01–1.09; p = 0.03), and elevated body mass index (OR 1.22, 95% CI 1.02–1.47, p = 0.03) were identified as risk factors for hemorrhage in the exploratory analysis.

Endoscopic hemostasis may help avoid emergency surgery in GIST‐related hemorrhage when hemorrhage points are clearly visualized. Ulceration may serve as a predictive factor for hemorrhage; therefore, early surgical intervention should be considered in GISTs with ulceration.