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

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.

A Case of Mantle Cell Lymphoma of Small Bowel Presenting Recurrent Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Lower gastrointestinal bleeding is difficult to localize despite advanced diagnostic procedures such as colonoscopy, small bowel series, mesenteric angiography and radionuclide scan. We had experienced a case of mantle cell lymphoma of small bowel. In this case, the cause of recurrent lower gastrointestinal bleeding and abdominal pain was not defined despite extensive preoperative evaluation. We diagnosed this case as mantle cell lymphoma after exploratory laparotomy.