Multidisciplinary management of refractory malignant upper gastrointestinal bleeding in metastatic gastric adenocarcinoma

Upper gastrointestinal bleeding (UGIB) secondary to malignancy is frequently refractory to conventional endoscopic therapies. We report a man in his 60s who presented with severe anaemia, melaena and haemodynamic instability. Urgent investigation demonstrated a friable, actively bleeding fundal mass with imaging features suspicious for metastatic gastric malignancy. Standard haemostatic measures, including epinephrine injection and haemostatic clips, failed to achieve bleeding control, resulting in progressive transfusion dependence. After multidisciplinary review, salvage endoscopic haemostasis was achieved using a haemostatic powder, followed by selective embolisation of the left gastric artery to consolidate haemostatic control. The patient stabilised without further transfusion requirements and was discharged with community palliative care support.

This case illustrates the diagnostic and therapeutic complexity of refractory malignant UGIB and the need for a coordinated multidisciplinary strategy—spanning gastroenterology, interventional radiology and palliative care—guided by the evolving clinical picture and goals of care.