Gastric Lesions After Hepatic Arterial Infusion of I-131-Lipiodol or Chemo-Embolization in Patients with Hepatocellular Carcinoma

Transcatheter arterial chemoembolization(TACE) has been used to treat patients with unresectable hepatocellular carcinoma(HCC). TACE may result in gastrointestinal complications because of an unavoidable infusions of embolic materials or antineoplastic drugs into the gastroduodenal and right gastric arteries. The incidence, endoscopic and histologic features of gastriclesions were investigated in 12 patients with inoperable HCC after hepatic arterial infusionof I-131-Lipiodol or chemo-embolization(TACE).

The results were as follows ;

1) Symptoms such as epigastic pain(five cases), nausea(three cases), and fever(two cases)developed in 9 patients(75%) after TACE.

2) Endoscopic findings after TACE were as follows ; The development of gastric lesionswas evident in five of the 12(41.7%). In three cases, gastric erosions were present, and theother two had acute gastritis.

3) The lesions were located on the antrum and body of the stomach, and the most commonsite was the gastric antrum(four cases).

4) Histologic findings of four cases with gastric lesions after TACE were as fo11ows : Twocases of gastritis, one case of erosion and intestinal metaplasia, and one case of erosion andatypical glandular hyperplasia.

In conclusion, the development of these gastric lesions after TACE may be due to mucosalischemia caused by embolic materials, the toxic effect of antineoplastic drugs or radioactiveagents infused, stress, or to accompanying cirrhosis. In light of these events, upper gastrointestinalendoscopy should be added to the usual examinations done for patients undergoing TACE.