Microvascular injury in persistent gastric ulcers after yttrium-90 microsphere radioembolization for liver malignancies

Sun, Belinda; Lapetino, Shawn; Diffalha, Sameer Al; Yong, Sherri; Gaba, Ron C.; Bui, James T.; Koppe, Sean; Garzon, Steven; Guzman, Grace

doi:10.1016/j.humpath.2015.10.016

Cited by 35 publications

(10 citation statements)

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“…Most frequently, the ulcers related to SIRT are located in the antrum, the pyloric region or the duodenum [4,17] which is most likely linked to reasons of vascular supply and reallocation of Yttrium microspheres from other parts of the stomach wall. Although half-life time of Yttrium 90 is 64 hours with complete determination of radiation within 14 days after the procedure, ulcers may occur months after the intervention [9] as it is documented in our present case. The first upper GI endoscopy one month after the SIRT application revealed only gastritis with progression to gastric ulceration in the next evaluation three months later.…”

Section: Discussionsupporting

confidence: 55%

“…In addition, the persistence of ulcerations over two years with even slightly worsening and the anti-acid resistance point against an exclusive role of acute radiation induced damage in our patient. Small vessel damage caused by the SIRT application as a reason for chronic ischemia was named as a possible mechanism for this phenomenon [9,18]. In our patient, ischemic changes were seen in all biopsy material taken after SIRT, progressing from minimal reactive changes of the antral mucosa in the first specimen, to extensive ischemic changes causing architectural distortion of the antral mucosa with ulceration, loss of antral glands and prominent dilatation of small vessels.…”

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

“…Gastrointestinal adverse effects can occur, one of them being caused by dislocation of Yttrium microspheres into the circulation of other parts of the gastrointestinal tract causing abdominal pain, nausea, vomiting, anorexia and gastroduodenal ulceration [1,2,[4][5][6][7][8][9]15]. These gastric complications occur with an incidence of 4-27 % [9]. Although most of the reported side effects are in general mild allowing the use of SIRT also in older patients and patients with worse performance status, isolated cases of major bleeding with the need for gastrectomy are described in the literature [1,4,8,16].…”

Section: Discussionmentioning

confidence: 99%

“…Acute gastrointestinal complications from gastritis to gastric ulceration, bleeding and perforation have been reported. The clinical spectrum and management is wide from total spontaneous healing to gastrectomy and death [2,[4][5][6][7][8][9]. We herein present the case of a patient with a more than two-year-long persistent, symptomatic ulceration of the gastric antrum with pyloric stenosis after a single SIRT for treatment of intrahepatic cholangiocellular carcinoma.…”

Section: Introductionmentioning

confidence: 99%

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Chronic gastric ulcer disease complicating selective internal radiation therapy (SIRT) in a patient with cholangiocellular carcinoma

et al. 2019

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Selective internal radiation therapy (SIRT) is a therapeutic option for primary and metastatic liver tumors. Microspheres containing Yttrium 90, a beta-emitting radionuclide, are administered into the hepatic artery allowing selective internal radiation of a liver tumor. SIRT-related complications may appear due to migration of the radiation microspheres to organs distant from the tumor site. In order to prevent these complications, unintended non target embolization of Yttrium microspheres has to be avoided. However, data from external-beam radiation therapy (EBRT) suggests that the stomach/small bowel may actually be less radiosensitive than the liver. Gastric ulcers, a well-known SIRT-related complication, may therefore not only be caused by local radiation but also by unusual accumulation of microspheres in the submucosa and small vessel damage. We herein report a more than two- year-long persisting, highly symptomatic, non-neoplastic ulceration of the gastric antrum leading to pyloric stenosis caused by SIRT therapy with Yttrium 90 microspheres for the treatment of intrahepatic cholangiocellular carcinoma. The chronic courses of the ulcer disease together with the specific histological features highlight the pivotal role of radiation-induced small vessel damage in SIRT-induced adverse events.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chronic gastric ulcer disease complicating selective internal radiation therapy (SIRT) in a patient with cholangiocellular carcinoma

et al. 2019

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Diagnosis, pathophysiology, and treatment of SIRT-induced gastroduodenal ulcers: A systematic literature review

Belcaid¹,

Vinciane

Vouche

et al. 2020

Surgical Oncology

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Background: Selective Internal Radiation Therapy (SIRT) is a therapeutic modality in patients with hepatocellular carcinoma or liver metastases. Complications due to SIRT-induced gastric ulcers are seen in less than 5% of patients but there is no consensus for management of this rare side effect. We conducted a systematic review to analyze the efficacy of medical treatment of SIRT-induced ulcers. Methods: This systematic review was conducted in accordance with the PRISMA guidelines. We developed the research question following the population, intervention, comparison, outcome, and study design (PICOS) format. We identified studies and cases reporting patients with gastric and/or duodenal (=population) ulcers treated with medical therapy with proton pump inhibitor (PPI), antacid, or sucralfate, alone or in combination (=intervention). We did not require that studies include a control group. We included studies reporting the evaluation of the medical and/or surgical treatment (=outcomes). Results: Out of 219 articles, 29 articles were included, resulting in analysis of data for a total of 51 patients who had a SIRT-induced gastric and/or duodenal ulcer treated with medication, surgery, or both. Twenty-eight patients (55%) were reported to have SIRT-induced ulcers that improved after initiation of PPI, antacid, or sucralfate treatment (alone or in combination). Twenty-three patients (45%) were reported to be refractory to medical treatment and surgery was performed in 7 out of 23 patients (30%). Conclusions: About 45% of SIRT-induced gastroduodenal ulcers are refractory to medical treatment with PPI, antacid, or sucralfate, alone or in combination. Surgery is an effective treatment in patients who are refractory to medical treatment and who have intense symptoms.

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Non-Neoplastic Pathology of the Gastrointestinal Tract

2020

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This book concisely summarises non-neoplastic gastrointestinal (GI) pathology and provides histopathologists aiming to refresh or expand their knowledge with a practical approach to the interpretation of biopsies. It focuses on GI biopsies, but also covers the pathology of resections and other organs where appropriate. The editor and contributors bring their expertise as practicing diagnostic pathologists across Europe and the US. Examples of topics include inflammatory bowel disease, infections, vascular disorders, and inflammatory conditions specific to various anatomical sites. Fact sheets, practice points and tables facilitate rapid assimilation of information and enhance the reader's experience, and with additional access to the full online version, including expandable images on Cambridge Core, achieve accuracy every time. High-quality illustrations are also numerous, and references are relevant and reliable. This book is a practical, readable and up-to-date asset for any pathologist encountering GI biopsies.

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Microvascular injury in persistent gastric ulcers after yttrium-90 microsphere radioembolization for liver malignancies

Cited by 35 publications

References 8 publications

Chronic gastric ulcer disease complicating selective internal radiation therapy (SIRT) in a patient with cholangiocellular carcinoma

Chronic gastric ulcer disease complicating selective internal radiation therapy (SIRT) in a patient with cholangiocellular carcinoma

Diagnosis, pathophysiology, and treatment of SIRT-induced gastroduodenal ulcers: A systematic literature review

Non-Neoplastic Pathology of the Gastrointestinal Tract

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