Gastric ulcer after prophylactic balloon-occluded retrograde transvenous obliteration.
A 74-year-old man with compensated hepatitis C virus-related liver cirrhosis was admitted for the treatment of small hepatocellular carcinoma (HCC) by radiofrequency ablation therapy (RFA). As a routine pretreatment examination, gastrointestinal endoscopy was performed, and large nodular varices were observed in the gastric fornix, with telangiectasia on top of the varices. As soon as the RFA was completed, prophylactic balloon-occluded retrograde transvenous obliteration (B-RTO) was performed. Seven days after the B-RTO, the patient complicated of upper abdominal pain. Gastrointestinal endoscopy was performed, and a deep ulcer, located at the top of the tumor-shaped gastric varices, was found. The ulcer showed rapid healing after 1-week administration of a proton pump inhibitor (PPI). A severe ulcer after a B-RTO procedure, is extremely rare, because sclerosing agents rarely flow into the gastric mucosa. The ulcer in this patient was deep and large, and it may have been due to direct mucosal damage caused by the sclerosing agent, because mucosal telangiectasia on top of the varices was observed before the B-RTO. It is likely that, in this patient, the mucosal vessels communicated with the submucosal large varices, and ethanolamine oleate (EOI) flowed into the gastric mucosa via this communication. Based on our experience, we recommend periodic follow-up endoscopy.
Takuma
Yoshitaka
Y
Department of Internal Medicine, National Hospital Organization Iwakuni Clinical Center, 2-5-1 Kuroiso-cho, Iwakuni, Yamaguchi, 740-8510, Japan.
Nouso
Kazuhiro
K
Takayama
Hiroki
H
Makino
Yasuhiro
Y
Saito
Shunsuke
S
Tanaka
Shouichi
S
Ogata
Masatoshi
M
Ohta
Takeyuki
T
Kubota
Junichi
J
Iwamuro
Masaya
M
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy; D017115:Catheter Ablation; D002404:Catheterization; D005773:Gastroscopy; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D009829:Oleic Acids / Q000009:adverse effects* / Q000627:therapeutic use; D011859:Radiography; D012597:Sclerosing Solutions / Q000009:adverse effects* / Q000627:therapeutic use; D015911:Sclerotherapy; D013276:Stomach Ulcer / Q000139:chemically induced*
D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate