Factors Associated with the Development of Gastroduodenal Lesions after Transcatheter Arterial Embolization in a Hepatocellular Carcinoma

Choi, Jung Il; Ha, Seung Su; Jeon, Seong Woo; Cho, Jae Hyun; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo; Reom, Heon Kyu; Kim, Yong Joo

Abstract

BACKGROUND/AIMS: Gastroduodenal lesions such as erosions and ulcers are less infrequent complications after transcatheter arterial embolization (TAE) procedures. This study was conducted to clarify the incidence and associated factors of post-TAE gastroduodenal lesions.
METHODS
Cases involving 142 patients with unresectable hepatocellular carcinoma (HCC) who underwent TAE during 70 months were retrospectively analyzed. Endoscopic examinations were performed before and after TAE. Patients were classified into two groups depending upon whether gastroduodenal lesions developed or not.
RESULTS
New gastroduodenal lesions developed in 32 of 142 patients (22.5%) within 3 months of TAE. Of these, 14 patients (9.9%) developed upper gastrointestinal bleeding. There were no significant differences in clinical and biochemical characteristics between the two groups (p>0.05). There was also no significant difference in catheter selection level, tumor type, number of TAE, use of gelform between the two groups (p>0.05). However, the cases involving large tumor size (>8 cm) and angiographical abnormalities of hepatic arteries including atypical branching, vascular tortuosity, spasms or intimal dissection during the procedure, infusion of embolizing materials adjacent to vessels supplying the stomach or duodenum, had more post-TAE gastroduodenal lesions. These two factors were found to significantly affect the development of post-TAE gastroduodenal lesions by multivariate analysis (p<0.05).
CONCLUSIONS
The major factors associated with the development of post-TAE gastroduodenal lesions are large tumor sizes and angiographical abnormalities of hepatic arteries. Upper gastrointestinal endoscopy should be performed as follow-up examinations in these patients.