Risk factors for mortality in patients with gastric adenocarcinoma presenting with acute haemorrhage.

We collected clinical, laboratory and endoscopic data prospectively in patients presenting with acute non-variceal upper gastrointestinal bleeding admitted to the care of one surgical team. During a 30-month period 52 patients were subsequently proven to have gastric adenocarcinoma; 30 patients underwent elective operation, and emergency surgery for bleeding was performed on 14 occasions. There were 13 hospital deaths (25%), 13.5% at 30 days. Emergency surgery was associated with a higher mortality rate (42.9%) than elective procedures (13.3%) (P less than 0.03). Factors associated with a poor prognosis were active haemorrhage at initial endoscopy, an admission blood urea nitrogen greater than 16 mmol/l, preoperative transfusion greater than 4 units, total transfusion greater than or equal to 9 units and a lowest recorded haemoglobulin during hospitalization of less than 7.5 g/dl. The unacceptably high mortality rate associated with surgery for continued haemorrhage or rebleeding episodes suggest that earlier elective operative intervention be advocated in patients presenting with acute bleeding and in whom gastric cancer is visualized. This is recommended particularly if the initial bleeding episode is severe, or active haemorrhage is visualized during initial endoscopy.