Not Your “Y”sual Gastritis: Gastrointestinal Complications of Selective Internal Radiation Therapy Sameer Qazi, MD; Heather Figurelli, DO; Hymie Kavin, MD Department of Medicine, Advocate Lutheran General Hospital. BACKGROUND:. RESULTS:. DISCUSSION:. Hospital Course
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Gastrointestinal Complications of Selective Internal Radiation Therapy
Sameer Qazi, MD; Heather Figurelli, DO; Hymie Kavin, MD
Department of Medicine, Advocate Lutheran General Hospital
Intra-arterial infusion of Yttrium-90 microspheres is becoming more frequently used for loco regional radiation of unresectable hepatic neoplasms
The microspheres used in selective internal radiation therapy (SIRT) provide 3X greater local radiation in the tumor tissue compared with standard selective external beam radiation (1).
The microspheres emit β-radiation as they decay in the tumor microvasculature for resultant tumor necrosis (1).
Compared to external beam radiation, there is reduced risk of radiation hepatitis, making it a favorable treatment option (2).
Prophylactic embolization of the gastroduodenal artery and right hepatic artery is recommended to prevent inadvertent gastric and duodenal microsphere deposition (3).
The incidence of gastrointestinal ulceration is < 5% if proper pre-treatment techniques are applied (3).
Complications occur in the setting of collateral vascular circulation, unrecognized arterial anatomic variant, and change of flow dynamics during infusion (2,3).
SIRT technique is being used more frequently and awareness of complications is important.
Fig 3: Surface erosions, inflammation (dashed)
Embedded Yttrium-90 microspheres (solid)
Fig 1: Gastric antrum with ulceration and necrosis
Fig 4: Yttrium-90 microspheres embedded in lamina propria
The patient was successfully managed with omeprazole and sucralfate. She did not require surgical intervention.
Fig 2: Pyloric channel necrosis