title: Gastric and duodenal obstruction in patients with cholangiocarcinoma in the porta hepatis: increased prevalence after radiation therapy.
abstract: OBJECTIVE
  Our objective was to study the imaging findings in patients who had gastric and duodenal obstruction as a long-term complication of cholangiocarcinoma and to determine if the obstruction was associated with radiation therapy.
  
  
  METHODS
  Between 1973 and 1989, 96 patients had either curative resection or palliative stenting for cholangiocarcinoma involving the hepatic duct bifurcation. Sixty-three (66%) also received adjuvant radiation therapy ranging from 4960 to 7220 rad (cGy). Gastric outlet or duodenal obstruction or both developed subsequently in seven of the 63 patients treated with radiation therapy. Radiographic studies, including upper gastrointestinal series and CT, and medical and surgical records for these seven patients were retrospectively reviewed.
  
  
  RESULTS
  Upper gastrointestinal series in the seven patients with obstruction showed narrowing of the lumen, deformity and enlargement of gastric and duodenal mucosal folds, and delayed gastric emptying. CT performed in five of the seven patients showed thickening of the wall of the gastric antrum and small bowel and retained food and fluid within the stomach. All seven patients required gastrojejunostomy; at surgery, dense adhesions and fibrosis were found, and it was not evident whether the obstruction was due to the tumor or to radiation fibrosis. However, because this complication was seen only after radiotherapy, it was presumed to be radiation fibrosis.
  
  
  CONCLUSIONS
  Our experience suggests that radiation therapy increases the risk of postoperative gastric and duodenal obstruction in patients undergoing surgery for cholangiocarcinoma.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287.
authors.forename: G T
authors.initials: GT
authors.lastname: Mogavero
authors.forename: B
authors.initials: B
authors.lastname: Jones
authors.forename: J L
authors.initials: JL
authors.lastname: Cameron
authors.forename: J
authors.initials: J
authors.lastname: Coleman
mesh_terms: D002759:Adenoma, Bile Duct / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D001650:Bile Duct Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D003131:Combined Modality Therapy; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012307:Risk Factors; D014057:Tomography, X-Ray Computed