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Title: Root Cause Analysis of Gastroduodenal Ulceration After Yttrium-90 Radioembolization

IntroductionA root cause analysis was performed on the occurrence of gastroduodenal ulceration after hepatic radioembolization (RE). We aimed to identify the risk factors in the treated population and to determine the specific mechanism of nontarget RE in individual cases. Methods: The records of 247 consecutive patients treated with yttrium-90 RE for primary (n = 90) or metastatic (n = 157) liver cancer using either resin (n = 181) or glass (n = 66) microspheres were reviewed. All patients who developed a biopsy-proven microsphere-induced gastroduodenal ulcer were identified. Univariate and multivariate analyses were performed on baseline parameters and procedural data to determine possible risk factors in the total population. Individual cases were analyzed to ascertain the specific cause, including identification of the culprit vessel(s) leading to extrahepatic deposition of the microspheres. Results: Eight patients (3.2 %) developed a gastroduodenal ulcer. Stasis during injection was the strongest independent risk factor (p = 0.004), followed by distal origin of the gastroduodenal artery (p = 0.004), young age (p = 0.040), and proximal injection of the microspheres (p = 0.043). Prolonged administrations, pain during administration, whole liver treatment, and use of resin microspheres also showed interrelated trends in multivariate analysis. Retrospective review of intraproceduralmore » and postprocedural imaging showed a probable or possible culprit vessel, each a tiny complex collateral vessel, in seven patients. Conclusion: Proximal administrations and those resulting in stasis of flow presented increased risk for gastroduodenal ulceration. Patients who had undergone bevacizumab therapy were at high risk for developing stasis.« less
Authors:
 [1] ;  [2] ; ;  [1] ;  [3] ; ;  [1]
  1. Stanford University School of Medicine, Division of Interventional Radiology (United States)
  2. Stanford University School of Medicine, Division of Gastroenterology and Hepatology (United States)
  3. Stanford University School of Medicine, Division of Nuclear Medicine and Molecular Imaging (United States)
Publication Date:
OSTI Identifier:
22207978
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 36; Journal Issue: 6; Other Information: Copyright (c) 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; INJECTION; LIVER; MICROSPHERES; MULTIVARIATE ANALYSIS; PATIENTS; REVIEWS; ULCERS; YTTRIUM 90 RADIOEMBOLIZATION