Radiation therapy increases the risk of hepatobiliary complications in short bowel syndrome

Patients developing short bowel syndrome (SBS) are at risk for hepatobiliary complications. Radiation enteritis and radiation-induced liver disease are potential complications of radiation therapy (XRT). The authors hypothesized that SBS patients with a history of abdominal XRT would be at increased risk for hepatobiliary complications.

The authors reviewed 92 adult patients developing SBS as a complication of operation for malignancy (n = 37) and/or XRT (n = 55). Hepatobiliary disease was evaluated by liver function tests, radiologic imaging, endoscopy, and histologic studies.

Rectal cancer was the most frequent tumor in both groups (36% vs 35%). There were significantly more ovarian cancers (18% vs 3%, P < .05) in the radiation group and fewer desmoid tumors (0% vs 24%, P < .05). Intestinal remnant length was similar, but radiation patients more frequently had colon present (87% vs 62%, P < .05) and were less likely to have type I anatomy (33% vs 65%, P < .05). Radiation patients were less likely to be weaned off parenteral nutrition (PN; 16% vs 41%, P < .05). Cirrhosis/portal hypertension was more frequent in the radiation group (35% vs 11%, P < .05). Radiographic evidence of fatty liver, end-stage liver disease and the risk of cholelithiasis post-SBS were similar in both groups.

SBS patients with a history of XRT were more likely to develop cirrhosis and portal hypertension than SBS patients with malignancy alone. Radiation SBS patients were less likely to wean from PN despite more favorable intestinal anatomy.