Iatrogenic gastroduodenal ulcers during hepatic intra-arterial chemotherapy.
OBJECTIVE
Various percentages of iatrogenic gastroduodenal ulcers during hepatic intra-arterial chemotherapy have been reported in the literature. The aim of this study was to analyze a homogeneous cohort of patients in order to evaluate the evolution and management of this complication.


METHODS
We retrospectively reviewed the clinical charts of 80 patients with primary or metastatic liver tumors who received 186 hepatic arterial infusion chemotherapy courses of 5-fluorouracil, cisplatin and mitomycin-C. All of the patients complaining of upper gastrointestinal symptoms during or after hepatic arterial infusion underwent esophagogastroduodenoscopy.


RESULTS
Esophagogastroduodenoscopy was performed in 14 patients, all of whom had gastroduodenal ulcers. Two of ten investigated patients were Helicobacter pylori positive. All of the patients were treated with a proton pump inhibitor and five also received major analgesics. All of the ulcers healed without complications. Six patients did not continue with hepatic arterial infusion for reasons other than ulcers. Eight patients received a subsequent hepatic intra-arterial chemotherapy course, five despite the persistence of an active ulcer.


CONCLUSIONS
Iatrogenic gastroduodenal ulcers are probably due to ischemia and the direct toxicity of the anticancer agents. They are Helicobacter pylori independent and do not represent an absolute contraindication for the continuation of hepatic intra-arterial chemotherapy.
Ravizza
D
D
Endoscopy-Gastroenterology Division, European Institute of Oncology, Milan, Italy. davide.ravizza@ieo.it
Fazio
N
N
Fiori
G
G
Crosta
C
C
Orsi
F
F
Grasso
R
R
Medici
M
M
Ferretti
G
G
de Braud
F
F
D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D016145:Endoscopy, Digestive System; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease; D007261:Infusions, Intra-Arterial / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D016685:Mitomycin; D002945:Cisplatin; D005472:Fluorouracil