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Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres.

Yim SY, Kim JD, Jung JY, Kim CH, Seo YS, Yim HJ, Um SH, Ryu HS, Kim YH, Kim CS, Shin E - Clin Mol Hepatol (2014)

Bottom Line: Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma.Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening.Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.

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Related in: MedlinePlus

Upper endoscopy. Huge geographic ulceration with easy-touch bled, denudated friable mucosae is noted along the lesser curvature of gastric antrum and mid-body.
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Figure 3: Upper endoscopy. Huge geographic ulceration with easy-touch bled, denudated friable mucosae is noted along the lesser curvature of gastric antrum and mid-body.

Mentions: Three weeks later, TARE was performed. Prior to the embolization, empirical coil embolization for the gastroduodenal artery was done to prevent complication of non-target lesion. A dose of 0.85 GBq of 90Y microspheres was delivered via left hepatic artery and right posterior segmental artery, through 2.7F microcatheter (Fig. 2). Immediately after the procedure, patient complained severe abdominal pain but post-TARE scan without injection of Tc-99m MAA demonstrated tumoral uptake of 90Y but no gastrointestinal uptake was observed. Pain was controlled with tramadol and the patient was discharged one week after TARE. However, the patient was readmitted due to severe abdominal pain four days after discharge. Upper endoscopy revealed geographic active ulcer at the lesser curvature of gastric antrum and mid-body. Histopathologic findings of endoscopic biopsy showed several deposited microspheres without evidence of Helicobacter pylori infection. Gastric ulcer was treated with full ulcer medications including an intravenous bolus followed by continuous-infusion of proton pump inhibitor. Follow-up enhanced computed tomography which was performed one month after TARE showed diffuse gastric wall thickening of antrum and lower body while HCC nodules in segment 4 and 7 were completely treated without recurrence. As abdominal pain failed to resolve with continuous medications, follow-up upper endoscopy was done two weeks later. Worsening of ulcerative mucosal lesions with exudative bases accompanied by diffuse mucosal friability and easy-touch bleeding were noted. Three additional endoscopic examinations were done to assess the lesions, but the aforementioned ulcers as well as the territory of the lesion were not grossly changed (Fig. 3).


Gastrectomy for the treatment of refractory gastric ulceration after radioembolization with 90Y microspheres.

Yim SY, Kim JD, Jung JY, Kim CH, Seo YS, Yim HJ, Um SH, Ryu HS, Kim YH, Kim CS, Shin E - Clin Mol Hepatol (2014)

Upper endoscopy. Huge geographic ulceration with easy-touch bled, denudated friable mucosae is noted along the lesser curvature of gastric antrum and mid-body.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197179&req=5

Figure 3: Upper endoscopy. Huge geographic ulceration with easy-touch bled, denudated friable mucosae is noted along the lesser curvature of gastric antrum and mid-body.
Mentions: Three weeks later, TARE was performed. Prior to the embolization, empirical coil embolization for the gastroduodenal artery was done to prevent complication of non-target lesion. A dose of 0.85 GBq of 90Y microspheres was delivered via left hepatic artery and right posterior segmental artery, through 2.7F microcatheter (Fig. 2). Immediately after the procedure, patient complained severe abdominal pain but post-TARE scan without injection of Tc-99m MAA demonstrated tumoral uptake of 90Y but no gastrointestinal uptake was observed. Pain was controlled with tramadol and the patient was discharged one week after TARE. However, the patient was readmitted due to severe abdominal pain four days after discharge. Upper endoscopy revealed geographic active ulcer at the lesser curvature of gastric antrum and mid-body. Histopathologic findings of endoscopic biopsy showed several deposited microspheres without evidence of Helicobacter pylori infection. Gastric ulcer was treated with full ulcer medications including an intravenous bolus followed by continuous-infusion of proton pump inhibitor. Follow-up enhanced computed tomography which was performed one month after TARE showed diffuse gastric wall thickening of antrum and lower body while HCC nodules in segment 4 and 7 were completely treated without recurrence. As abdominal pain failed to resolve with continuous medications, follow-up upper endoscopy was done two weeks later. Worsening of ulcerative mucosal lesions with exudative bases accompanied by diffuse mucosal friability and easy-touch bleeding were noted. Three additional endoscopic examinations were done to assess the lesions, but the aforementioned ulcers as well as the territory of the lesion were not grossly changed (Fig. 3).

Bottom Line: Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma.Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening.Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Transcatheter arterial radioembolization (TARE) with Yttrium-90 ((90)Y)-labeled microspheres has an emerging role in treatment of patients with unresectable hepatocellular carcinoma. Although complication of TARE can be minimized by aggressive pre-evaluation angiography and preventive coiling of aberrant vessels, radioembolization-induced gastroduodenal ulcer can be irreversible and can be life-threatening. Treatment of radioembolization-induced gastric ulcer is challenging because there is a few reported cases and no consensus for management. We report a case of severe gastric ulceration with bleeding that eventually required surgery due to aberrant deposition of microspheres after TARE.

Show MeSH
Related in: MedlinePlus