P1675 - Gastric Ulcers Unveiled: The Fallout from Radioactive Beads

Angela Barnes, MD, MBChB¹, Sandeep Yerraguntla, ¹, Gaurav Gopu, ², Amanda Barrett, MD³, Humberto Sifuentes, MD^3
1Medical College of Georgia at Augusta University, Augusta, GA; ²Medical College of Georgia at Augusta University, Cumming, GA; ³Augusta University, Augusta, GA

Introduction: Yttrium-90 (Y90) microsphere radioembolization has emerged as a widely used technique to treat hepatic neoplasms. Given the growing adoption of this technique, it’s important to be mindful of its adverse effects including gastritis & gastric ulcers resulting from the migration or abnormal localization of the microspheres. We present a case of severe gastric ulceration associated with embedded radioactive Y90 beads

Case Description/Methods: A 47-year-old female with a history of colorectal adenocarcinoma with liver metastases status post radiotherapy with Y90 radioembolization, presented with a month’s history of intractable nausea and vomiting, epigastric pain and a 15-pound weight loss. She had received radiotherapy with Y90 radioembolization 2 months prior. On examination, she appeared ill looking and dehydrated. Her abdomen was diffusely tender but without guarding or rebound tenderness. Laboratory test was notable for hemoglobin of 10.0g/dl, MCV of 65.2fl, Potassium of 3.2mEq/L, mildly elevated AST of 37U/L, and alkaline phosphatase of 136U/L. CT of the abdomen/pelvis showed a known hepatic flexure colonic mass with metastasis to the regional lymph nodes, liver and lungs. There was a heterogenous hypoattenuation of the liver, consistent with Y-90 embolization. EGD revealed a clean-based ulcer in the prepyloric region and erythematous and friable with multiple ulcerations at the lesser curvature of the stomach. Biopsies showed ulcerated gastric mucosa and granulation tissue with embedded round, foreign objects consistent with Y90 radioactive beads. The patient was subsequently placed on pantoprazole, iron supplements for anemia and Total Parenteral Nutrition due to her poor nutritional status. She is being followed up at the Heme-Oncology department with consideration of hospice care due to her poor prognosis from her cancer.

Discussion: Gastrointestinal ulceration is a known complication following hepatic radioembolization, often resulting from unintended embolization of non-target areas. Diagnostic assessment, including imaging studies and endoscopy, may be necessary to evaluate potential procedure-related complications. Currently, there is insufficient data to definitively ascertain the increased risk of gastrointestinal ulceration associated with different doses of radioembolic agents. Further research is recommended to gain a better understanding of the risk factors, mechanisms, and optimal management approaches for gastrointestinal complications following radioembolization procedures.



Disclosures:


Angela Barnes, MD, MBChB¹, Sandeep Yerraguntla, ¹, Gaurav Gopu, ², Amanda Barrett, MD³, Humberto Sifuentes, MD³. P1675 - Gastric Ulcers Unveiled: The Fallout from Radioactive Beads, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.