Anatomic and technical skill factor of gastroduodenal complication in post-transarterial embolization for hepatocellular carcinoma: a retrospective study of 280 cases.
OBJECTIVE
To reduce the possibility of gastroduodenal complications. The purpose of this retrospective study was to survey the literature and compare and discuss the incidence of post-transarterial embolization (TAE) gastroduodenal complications.


METHODS
We found reports describing 280 cases of hepatocellular carcinoma with TAE procedures done during the past 4 years and selected all of them for our study. Amongst these cases, 86 were suspected of suffering gastroduodenal complications within one month of post-TAE treatment. Fifteen of these cases were proved by pan-endoscopy to have gastroduodenal erosions or ulcerations. We reviewed the angiographic pictures in patient records to evaluate the possibility that anatomic and technical skill factors could explain the complications.


RESULTS
Amongst the 15 cases, 9 were primary lesions of the antrum and prepylorus; 4 had duodenal ulcer or erosions; 2 had mid-body lesions; none showed a lesion at the fundus or cardia region. Three cases had not received TAEs using our ideal method, and may be associated with possible regurgitation of gel-foam pieces into the right or left gastric arteries. Two cases involved sub-selective embolization at a distal point on the hepatic artery; one case was found by angiography to have complete occlusion of the celiac trunk.


CONCLUSIONS
Comparing our results with past cases of post-TAE gastroduodenal complications, we surmise that our relatively low incidence (5.3%) of gastric complications might be explained by our concerted efforts to improve our technical skills in multi-sequential, selective and super-selective approaches to the embolization of tumor vessels.
Leung
Ting-Kai
TK
Department of Diagnostic Radiology, Taipei Medical University Hospital, 252 Wu Hsing Street, Taipei 110, Taiwan, China.
Lee
Chi-Ming
CM
Chen
Hsin-Chi
HC
D000005:Abdomen / Q000098:blood supply; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000628:therapy*; D002983:Clinical Competence; D004378:Duodenal Diseases / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000628:therapy*; D012189:Retrospective Studies; D013270:Stomach / Q000098:blood supply; D013272:Stomach Diseases / Q000209:etiology*