MAKING DIAGNOSIS OF THE BLEEDING GASTRIC CANCER

Purpose: The aim of the study was to establish priorities in using instrumental techniques to diagnose the bleeding gastric cancer.

Methods and Materials: The clinical material included 50 patients with gastric cancer (with the ongoing -21 patients, or ceased 29 patients gastric bleeding). On admission the patients underwent an urgent esophagogastroduodenoscopy to identify the source of bleeding. The patients received an intensive hemostatic therapy, and alongside, within 3–7 days, the stomach was X-rayed in multiple views, and abdominal ultrasonography (US) was performed after filling the stomach with degassed fluid.

Results: Initial endoscopy helped to identify the source of bleeding in the stomach antrum in all patients. Total and subtotal involvement of the stomach in the malignant process was identified in 28% of the patients, the infiltrative forms of cancer with mucosal ulceration being prevailed. Endocsopy findings were indicative of a huge chronic gastric ulcer in 6 patients (12%), and of multiple acute gastric ulcers against the infiltrative mucosal abnormalities in 5 patients (10%). Exophytic growth of the tumour was identified in more than 50% of the patients and caused no difficulties for urgent diagnosis. Urgent US performed in 24 patients revealed the signs of gastric cancer and signs of tumour spreading (invasion, the presence of regional and peripheral lymph nodes, liver metastasis). US sensitivity in revealing the bleeding gastric cancer made 96%.

Conclusions: The developed diagnostic algorithm including US for gastric cancer patients helped to determine precisely the indications to operative treatment and to prepare the patients for the surgery of required extent.