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Gastroduodenal Ulceration Associated with Radioembolization for the Treatment of Hepatic Tumors: An Institutional Experience and Review of the Literature

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Abstract

Background

Microsphere radioembolization is a method of delivering radiation therapy directly to tumors, thereby minimizing toxicity to adjacent structures. Despite the relatively high precision of this modality, numerous adverse effects have been recognized. One particularly untoward complication is the development of severe gastroduodenal ulceration.

Methods

In order to further characterize gastroduodenal ulceration associated with radioembolization, our institutional experience as well as the reported literature were reviewed.

Results

The current evidence suggests that radioembolization-associated gastroduodenal ulceration results from inadvertent delivery of microspheres to the microvasculature of the gastrointestinal tract, leading to direct radiation toxicity. The reported incidence of this entity ranges between 2.9% and 4.8%. Most patients with this complication present with abdominal pain, often associated with nausea, vomiting, and anorexia. Symptoms can arise from hours to months after radioembolization treatment; diagnosis is made by endoscopic biopsy and histopathologic evaluation of the ulcer specimen. Radiation-induced ulcers have proven to be extremely difficult to treat. Current therapy based on acid suppression has had limited success, and the evidence for the addition of antioxidants and anti-inflammatory agents is still sparse.

Conclusions

The increasing utilization of radioembolization will lead to adverse events including gastroduodenal ulceration. This entity must be considered in any patient treated with radioactive microspheres presenting with symptoms of dyspepsia. Accurate diagnosis and aggressive treatment are necessary to improve patient outcomes.

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Acknowledgments

The authors have no financial arrangements or conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY, 10029, USA

    Steven Naymagon

  2. Department of Medicine, Division of Gastroenterology, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY, 10029, USA

    Richard R. P. Warner, Kalpesh Patel, Noam Harpaz & Michelle K. Kim

  3. Department of Pathology, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY, 10029, USA

    Noam Harpaz

  4. Department of Radiology, Division of Nuclear Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY, 10029, USA

    Josef Machac

  5. Department of Radiology, Division of Interventional Radiology, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY, 10029, USA

    Joshua L. Weintraub

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  1. Steven Naymagon
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Correspondence to Steven Naymagon.

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Naymagon, S., Warner, R.R.P., Patel, K. et al. Gastroduodenal Ulceration Associated with Radioembolization for the Treatment of Hepatic Tumors: An Institutional Experience and Review of the Literature. Dig Dis Sci 55, 2450–2458 (2010). https://doi.org/10.1007/s10620-010-1156-y

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  • DOI: https://doi.org/10.1007/s10620-010-1156-y

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