Hepatic radioembolization complicated by gastrointestinal ulceration

Gastric ulceration is a relatively uncommon but well-described complication of yttrium 90 (Y90) radioembolization therapy in the locoregional treatment of hepatic tumors. Meticulous attention to vascular anatomy, an assessment of antegrade hepatic arterial flow, and knowledge of the dynamic embolic effect of the chosen Y90 particulate at treatment are requirements to reduce the risk of nontarget embolization to gastrointestinal structures. Radiation-associated gastrointestinal ulceration is difficult to treat, and may be associated with gastrointestinal bleeding, bowel obstruction, and perforation. Surgical excision of the involved segment with bypass may be necessary. The increased use of coil embolization of at-risk vessels combined with administration of Y90 particulates with minimal embolic effect has reduced the incidence of radioembolization associated gastrointestinal ulceration.