Yttrium-90 microsphere induced gastrointestinal tract ulceration

Area of Science:

• Interventional Radiology
• Hepatobiliary Oncology
• Gastroenterology

Background:

• Radiomicrosphere therapy (RT) with yttrium-90 (90Y) microspheres is an established regional treatment for hepatic malignancies.
• This study investigates the incidence and severity of gastrointestinal (GI) complications following RT at a major academic institution.

Observation:

• A review of 27 patients undergoing RT between 2004 and 2007 identified three cases of GI bleeding.
• Angiographic review revealed varied vascular anatomies, and none of the affected patients had prophylactic gastroduodenal artery embolization.
• Endoscopic findings included erythema, mucosal erosions, and persistent gastric ulcers, with microspheres visible on biopsy.

Findings:

• Gastrointestinal ulceration is a rare complication of 90Y microsphere embolization.
• Complications can be severe, leading to persistent ulcers and, in one case, death from hemorrhage despite medical management.
• Prophylactic embolization of the gastroduodenal artery was not performed in the identified cases.

Implications:

• Gastrointestinal ulceration following RT, though infrequent, carries significant risks.
• Aggressive surgical intervention should be considered for refractory ulcers post-RT.
• Further research into prophylactic measures may be warranted to mitigate GI complications.