Endoscopic Hemostasis of Gastrointestinal Hemorrhage Form a Gastric Gastrointestinal Stromal Tumor by Local Application of Absolute Ethanol: A Case Report

Introduction: Successful hemostasis with endoscopic alcohol injection therapy (EAIT) has been first described in 1975. Data is lacking if this modality is helpful for bleeding from neoplasms in the gastrointestinal tract. We present a case of EAIT to treat bleeding from a gastric gastrointestinal stromal tumor (GIST). Case Description/Methods: A 65 year old female underwent esophagogastroduodenoscopy (EGD) for evaluation of melena. On EGD, a 5 cm gastric lesion with central ulceration and oozing was seen in the fundus of the stomach (Figure 1 - A). Large amount of clot like material was also seen in the body of stomach. Endoscopic ultrasound was performed that revealed a large hypoechoic lesion arising from the muscularis propria layer of the gastric fundus. Biopsy of the lesion was consistent with a GIST. Hemostat clip did not help with hemostasis and due to persistent bleeding from the lesion, 10 cc of absolute alcohol directly into the lesion. This resulted in adequate hemostasis (Figure 1-B) during the procedure and patient did not require any further blood transfusions. Patient was eventually referred for surgical resection of the lesion. Discussion: EAIT has previously been described as effective modality in treating bleeding from gastric and duodenal ulcers, gastric and duodenal vascular ectasias, Mallory-Weis tears and gastric adenocarcinoma. Alcohol causes dehydration and fixation of the tissue. In addition, there is vasoconstriction and necrosis of the vascular endothelium leading to thrombogenesis and hemostasis. Our case presents the first known application of EAIT in treating hemorrhage from a GIST. There were no complications with the use of EAIT in our case. Therefore, EAIT could offer a cheap, widely available, easy to perform and safe rescue technique for hemostasis in GIST’s, and possibly other neoplastic lesions.Figure 1.: A) Endoscopic view of active bleeding from GIST. B) Complete hemostasis achieved after EAIT.