P0811 - A Case of a Bleeding Gastric Ulcer Secondary to Y90 Treatment in a Metastatic Patient Managed Conservatively

Anand Thakkar, BS¹, Kunal Dalal, MD², Xinmin Zhang, MD², Avneet Singh, DO^2
1Philadelphia College of Osteopathic Medicine, Linwood, NJ; ²Cooper University Hospital, Camden, NJ

Introduction: Yttrium-90 (Y90) radioembolization is commonly used to treat hepatic tumors. With the increased use of

this technique a relatively rare complication occurring less than 5% is a gastric ulcer. Here we report a

case of Y90 induced gastric ulcer with a focus on presentation, endoscopy, and management to advise

for future cases.

Case Description/Methods: A 65 year old male with a history of treated urothelial carcinoma and rectal cancer s/p lower anterior

resection with metastasis recurrence to liver with two Y90 treatments presents outpatient 3 months

later for dyspepsia with hemoglobin (Hgb) of 10.1. He underwent EGD showing 20 mm of erythematous,

friable, sloughing mucosa in the gastric cardia which was biopsied. Pathology reported chronic

inflammation and foreign materials from Y90 representing radiation gastritis. He was subsequently

placed on PPI daily, but reported melenic stools 2 months later. Medication was increased to PPI BID

and sucralfate was added. He had rapid improvement of symptoms and self-discontinued medications,

then 1 month later had worsening melena with hospital admission with Hgb 5.8 requiring transfusions.

Repeat EGD showed a gastric cardia ulcer 15 mm (Figure A), and foreign spherical shaped purple

particles, morphologically consistent with Y90 radio-embolization microspheres, were found, as

illustrated in Figure B. He was restarted on PPI and sucralfate. One month later, repeat EGD showed

smaller 10 mm gastric cardia ulcer with pigmented spot. The patient continued PPI and carafate without

further signs of melena, but ultimately was placed on hospice 2 months later after SBO peritonitis.

Discussion: Most Y90 gastric ulcers occur near the pylorus, but this ulcer was noted in the gastric cardia. We

theorize despite mapping with right hepatic artery for deployment, there was aberrant flow of Y90

microspheres to gastric arteries. Patients can present with varying complaints from dyspepsia to

melena. Diagnosis requires direct visualization which show varying phases of delayed ulcer

development, but all pathology with foreign body of Y90 microspheres. There is no management

guideline, but generally patients are treated with PPIs with complications requiring invasive

interventions. Specifically, we propose sucralfate coadministration is currently underutilized and may

promote healing for this ulcer. This case highlights the presentation, diagnosis, and conservative

management of rare Y90 ulcers.



Disclosures:


Anand Thakkar, BS¹, Kunal Dalal, MD², Xinmin Zhang, MD², Avneet Singh, DO². P0811 - A Case of a Bleeding Gastric Ulcer Secondary to Y90 Treatment in a Metastatic Patient Managed Conservatively, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.