Abstract
Radiation-induced hemorrhagic gastritis is a relatively uncommon complication of irradiation that can be severe. However, appropriate treatment guidelines have not yet been established because of the small number of known cases. At our hospital, we encountered nine cases of radiation-induced hemorrhagic gastritis between July 2005 and July 2018. All patients initially underwent argon plasma coagulation (APC) for hemostasis. The treatment was highly effective, and hemostasis was successfully achieved in eight of the cases. Hemostasis could not be achieved in one case treated with APC; therefore, surgical resection was required. This patient had risk factors, such as liver cirrhosis and a history of abdominal surgery. Our case series suggests that APC is an effective hemostatic method that should be considered as the initial treatment option for radiation-induced hemorrhagic gastritis; however, surgical resection may be considered when the patient is at high risk for rebleeding.
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References
Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21:109–22.
DeCosse JJ, Rhodes RS, Wentz WB, et al. The natural history and management of radiation induced injury of the gastrointestinal tract. Ann Surg. 1969;170:369–84.
Japanese Society for Radiation Oncology. The 2020 guideline for radiation treatment Plan. 2020;4:53–58 (Japanese).
Chon YE, Seong J, Kim BK, et al. Gastroduodenal complications after concurrent chemoradiation therapy in patients with hepatocellular carcinoma: endoscopic findings and risk factors. Int J Radiat Oncol Biol Phys. 2011;81:1343–51.
Earnest DL, Trier JS. Radiation enteritis and colitis. In: Sleisenger MH, Fordtran JS, editors. Gastrointestinal disease: pathophysiology, diagnosis and management. 4th ed. Philadelphia: Saunders; 1989. p. 1369–82.
Meyer JJ, Willett CG, Czito BG. Emerging role of intensity-modulated radiation therapy in anorectal cancer. Expert Rev Anticancer Ther. 2008;8:585–93.
Goldstein HM, Rogers LF, Fletcher GH, et al. Radiological manifestations of radiation-induced injury to the normal upper gastrointestinal tract. Radiology. 1975;117:135–40.
Zhang L, Xie XY, Wang Y, et al. Treatment of radiation-induced hemorrhagic gastritis with prednisolone: a case report. World J Gastroenterol. 2012;18:7402–4.
Shukuwa K, Kume K, Yamasaki M, et al. Argon plasma coagulation therapy for a hemorrhagic radiation-induced gastritis in patient with pancreatic cancer. Intern Med. 2007;46:975–7.
Kojima Y, Takeuchi T, Nishida S, et al. A case series of radiation-induced hemorrhagic gastroduodenitis. Intern Med. 2021;60:2529–35.
Tatsis V, Peponi E, Papadopoulos G, et al. Subtotal gastrectomy for diffused hemorrhagic gastritis induced by radiation, following liver resection for hilar cholangiocarcinoma. A case report. Int J Surg Case Rep. 2016;18:30–2.
Staiano T, Grassia R, Iiritano E, et al. Treatment of radiation-induced hemorrhagic gastritis with endoscopic band ligation. Gastrointest Endosc. 2010;72:452–3.
Grover N, Johnson A. Aminocaproic acid used to control upper gastrointestinal bleeding in radiation gastritis. Dig Dis Sci. 1997;42:982–4.
Madala S, Polavarapu A, Gurala D, et al. Upper GI bleeding secondary to radiation gastritis in a patient with preexisting portal hypertensive gastropathy. Case Rep Gastroenterol. 2021;15:513–8.
Murphy JD, Adusumilli S, Griffith KA, et al. Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2007;68:801–8.
Cosset JM, Henry-Amar M, Burgers JM, et al. Late radiation injuries of the gastrointestinal tract in the H2 and H5 EORTC Hodgkin’s disease trials: emphasis on the role of exploratory laparotomy and fractionation. Radiother Oncol. 1988;13:61–8.
McKay MJ, Foster R. Pathobiology, irradiation dosimetric parameters and therapy of radiation-induced gastric damage: a narrative review. J Gastrointest Oncol. 2021;12:3115–22.
Kwak HW, Lee WJ, Woo SM, et al. Efficacy of argon plasma coagulation in the treatment of radiation-induced hemorrhagic gastroduodenal vascular ectasia. Scand J Gastroenterol. 2014;49:238–45.
Banerjee N, Javed A, Deepak D, et al. Hyperbaric oxygen therapy: an adjuvant treatment modality for chemo-radiation induced hemorrhagic gastritis. Trop Gastroenterol. 2011;32:248–50.
Flobert C, Cellier C, Landi B, et al. Severe hemorrhagic gastritis of radiation origin. Gastroenterol Clin Biol. 1998;22:232–4.
Brown C, Subramanian V, Wilcox CM, et al. Somatostatin analogues in the treatment of recurrent bleeding from gastrointestinal vascular malformations: an overview and systematic review of prospective observational studies. Dig Dis Sci. 2010;55:2129–34.
Yun HG, Kim HY, Kim DY, et al. Successful treatment of intractable bleeding caused by radiation-induced hemorrhagic gastritis using oral prednisolone: a case report. Cancer Res Treat. 2015;47:334–8.
Zhang L, Xia WJ, Zhang ZS, et al. Growth hormone used to control intractable bleeding caused by radiation-induced gastritis. World J Gastroenterol. 2015;21:9453–6.
White K, Henson CC. Endoscopically delivered Purastat for the treatment of severe haemorrhagic radiation proctopathy: a service evaluation of a new endoscopic treatment for a challenging condition. Frontline Gastroenterol. 2021;12:608–13.
Sekiya M, Uraoka T, Tajiri H. Novel hemostatic method for non-spouting bleeding from unidentified point in endoscopic submucosal dissection using a self-assembling peptide solution. Dig Endosc. 2021;33:70–1.
Maekawa S, Aoyama N, Shirasaka D, et al. Argon plasma coagulation for treatment of hemorrhagic radiation gastroduodenitis. Dig Endosc. 2002;14:5–8.
Morrow JB, Dumot JA, Vargo JJ 2nd. Radiation-induced hemorrhagic carditis treated with argon plasma coagulator. Gastrointest Endosc. 2000;51:498–9.
Wada S, Tamada K, Tomiyama T, et al. Endoscopic hemostasis for radiation-induced gastritis using argon plasma coagulation. J Gastroenterol Hepatol. 2003;18:1215–8.
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YI and KS contributed to the conception and drafting of the manuscript. TH contributed to the conception and drafting of the manuscript and the critical revision of the manuscript for important intellectual content. SY, YH, AI, TY, ST, YY, JF contributed to the critical revision of the manuscript for important intellectual content. All authors gave final approval of the article.
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Suzuki, K., Ikenoyama, Y., Hirasawa, T. et al. Clinical course and treatment of radiation-induced hemorrhagic gastritis: a case series study. Clin J Gastroenterol 16, 152–158 (2023). https://doi.org/10.1007/s12328-022-01750-1
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DOI: https://doi.org/10.1007/s12328-022-01750-1