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Updated: Jun 21, 2026
Intestinal Epithelial Regeneration in Response to Ionizing Irradiation
Published on: July 27, 2022
Radiation microsphere-induced GI ulcers after selective internal radiation therapy for hepatic tumors: an
Amulya Konda1, Michael A Savin, Mitchell S Cappell
1Department of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, Michigan, USA.
Background:
Intra-arterial infusion of yttrium-90 (Y-90) microspheres is locoregional radiation therapy for unresectable hepatic neoplasms. Literature on GI complications of this novel therapy is sparse.
Objectives:
Clinically and pictorially characterize selective internal radiation therapy (SIRT)-induced GI injury and review the published literature.
Design:
Retrospective chart analysis.
Setting:
Single-center tertiary referral community hospital.
Patients:
One hundred three patients treated with SIRT for hepatic neoplasms between 2006 and 2008.
Interventions:
SIRT for unresectable hepatic neoplasms followed by upper endoscopy with biopsy in symptomatic patients.
Outcome Measures:
GI ulcers after SIRT.
Results:
Five patients with suspected GI injury after SIRT were identified. Significant postprocedural symptoms included nausea/vomiting, odynophagia, hematemesis, and melena. Radiation ulcers occurred mostly in the gastric antrum, pylorus, and duodenum. Biopsy specimens of ulcer margins in 4 patients showed pathognomonic radiation microspheres. Angiographic review of the fifth patient revealed a previously unrecognized arterial branch supplying the corresponding region of GI ulceration noted on endoscopy.
Limitations:
Small retrospective study and follow-up limited by terminal disease states in most patients.
Conclusions:
The reported incidence of GI complications after SIRT for hepatic neoplasia varies from 3% to 24% of patients. Incidence can be minimized by strict adherence to published SIRT protocols. Diagnosis requires a high degree of clinical suspicion along with endoscopy and biopsy of ulcer margins. Characteristic radiation microspheres in biopsy specimens are pathognomonic. Gastroenterologists and pathologists must be cognizant of this complication.
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