Impact of liver cirrhosis on demographics and outcomes following esophagogastroduodenoscopy for non-variceal upper gastrointestinal bleeding in patients with gastric cancer.

Abstract

e16055 Background: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common complication among gastric cancer patients. Esophagogastroduodenoscopy(EGD) is one of the treatment modalities that can be used in their management. While liver cirrhosis has proved to be a crucial comorbidity leading to various EGD complications, there are currently no studies done on its impact among gastric cancer patients undergoing the procedure. We hereby propose to create a retrospective study to evaluate further. Methods: We found primary admissions for NVUGIB among gastric cancer patients using appropriate ICD-10 codes from the National Inpatient Sample(NIS). Our study was restricted to cases between 2016 and 2022. We further narrowed our selection to patients who underwent EGD. We compared the presence of various comorbidities, patient demographics, and complications between patients with and without liver cirrhosis. Results: Our selection yielded 2480 NVUGIB admissions among gastric cancer patients who underwent EGD. This involved 245(9.9%) cases of liver cirrhosis, who reported a lower mean age(64.29 years) than the non-cirrhosis group(68.20 years)(p < 0.01). While both groups contained primarily males, the prevalence was lower among the cirrhosis group (59.2% vs. 67.1%, p = 0.013). Around 12.2% of the cirrhosis group and 10.5% of the control group were using palliative care(p = 0.405). Our multivariable analysis found that patients with liver cirrhosis were more likely to report sepsis(aOR 4.432, p < 0.01), acute kidney injury(AKI)(aOR 4.055, p < 0.01), blood transfusion (aOR 1.502, p < 0.01), pneumonia (aOR 4.115, p < 0.01), and atelectasis(aOR 3.594, p < 0.01). Patients with liver cirrhosis stayed for 8.37 days on average, while a shorter stay of 5.26 days was noted in the control group(p < 0.01). In addition, the odds of all-cause mortality were higher(aOR 1.913, p = 0.037)(Table 1). Conclusions: Our real-world analysis found that among gastric cancer patients with NVUGIB who underwent EGD, liver cirrhosis patients were younger and were at heightened risk of multiple adverse effects, including sepsis, AKI, blood transfusion, pneumonia, atelectasis, and linked with a heavier healthcare burden. Setting up a multidisciplinary approach involving oncologists and gastroenterologists is crucial to developing a comprehensive strategy to minimize risks and improve their outcomes. Complications in gastric cancer patients with NVUGIB undergoing EGD with and without liver cirrhosis. Outcomes p-value aOR Lower 95% CI Upper 95% CI Death 0.037 1.913 1.04 3.52 Acute Kidney Injury <0.01 4.055 2.491 6.601 Blood transfusion <0.01 1.502 1.134 1.99 Pneumonia <0.01 4.115 2.535 6.678 Atelectasis <0.01 3.594 1.565 8.252 Sepsis <0.01 4.432 2.546 7.712