Clin Endosc.  2023 Nov;56(6):812-816. 10.5946/ce.2022.117.

Gastric cancer presenting with ramucirumab-related gastrocolic fistula successfully managed by colonic stenting: a case report

• Fukuya H
• Iboshi Y
• Wada M
• Sumida Y
• Harada N
• Nakamuta M
• Fujii H
• Ihara E

• KMID: 2547904
• DOI: http://doi.org/10.5946/ce.2022.117

Abstract

We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.

Keyword

Chemotherapy; Gastric cancer; Gastric fistula; Self expandable metal stent; Radiotherapy

Figure

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  Fig. 1. Features of primary gastric cancer before and during chemotherapy. (A) Esophagogastroduodenoscopy before the application of chemotherapy showed advanced gastric cancer at the anterior wall of the gastric antrum. (B) Enhanced computed tomography before the application of chemotherapy showed advanced gastric cancer at the gastric antrum. (C) Esophagogastroduodenoscopy after three cycles of ramucirumab plus paclitaxel. (D) Radiograph after three cycles of ramucirumab plus paclitaxel.

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  Fig. 2. Gastroduodenal stent placement for antral stenosis and appearance of gastrocolic fistula. (A) Radiography showed successful placement of gastric metallic stent for antral stenosis. (B) Computed tomography at 10 days after the placement of gastric metallic stent revealed a fistula (arrow) between the stomach and transverse colon. (C) Esophagogastroduodenoscopy showed gastrocolic fistula. (D) Colonoscopy showed gastrocolic fistula.

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  Fig. 3. Placement of a double colonic metal stent to cover the gastrocolic fistula. (A) Fluoroscopy showed a gastrocolic fistula. (B) Fluoroscopy showed an uncovered colonic metal stent placed in the transverse colon. (C) Fluoroscopy showed little leakage from the stomach to the transverse colon after stent-in-stent placement of a covered stent.

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