E0332 - Radiation-Induced Refractory Hemorrhagic Gastropathy Resulting in Transfusion Dependence

Simran Bhatti, MD¹, Ruchi Mangal, BS², Chad Barnhart, MD^1
1Henry Ford Hospital, Detroit, MI; ²Wayne State University School of Medicine, Detroit, MI

Introduction: Radiation induced hemorrhagic gastropathy is a rare and often serious complication of radiation therapy with no established management guidelines. We present a case of severe radiation induced hemorrhagic gastritis refractory to conventional therapeutic modalities.

Case Description/Methods: 54-year-old male with a past medical history of esophageal adenocarcinoma status post esophagectomy, chemotherapy, and low dose radiation. One month later, the patient presented to the ED for hematochezia with a hemoglobin level of 8.5 g/dl. Endoscopy revealed ulceration at the gastroesophageal anastomosis with oozing blood which was treated with argon plasma coagulation. The patient was readmitted due to outpatient labs showing a hemoglobin of 6.5 g/dl. He underwent four unsuccessful endoscopies with hemospray and APC. He was subsequently transferred to Henry Ford Hospital for escalation of care. On presentation vital signs were stable: BP 115/85 mmHg, HR 90 beats/min, and RR 15 breaths/min. Labs revealed a hemoglobin of 6.4 g/dl, platelet count of 155,000/L, PT of 12.1s, aPTT of 28.5 s, and INR of 1.1. He was started on sucralfate, protonix, and octreotide. Repeat EGD showed findings consistent with radiation induced gastropathy and arteriovenous malformations with diffuse hemorrhaging. The patient subsequently had six unsuccessful upper endoscopies with APC, hemospray, and radiofrequency ablation. Thoracic Surgery recommended ongoing medical management. Experimental treatments including aminocaproic acid, bevacizumab, and steroids were implemented with little benefit. Gastrectomy was subsequently recommended which the patient refused. He was transferred to a long-term acute care facility in order to continue supportive blood transfusions.

Discussion: The incidence of radiation induced hemorrhagic gastropathy is low, however, it is associated with a high mortality rate. Although gastrointestinal ulceration is common post radiation, the extent of bleeding seen in this patient is uncommon. Notably, there are no standard treatment guidelines in place for these cases. APC, radiofrequency ablation, and targeted prednisolone are often utilized to control bleeding. This is a unique case of highly refractory radiation induced hemorrhagic gastritis. Despite receiving low dose radiation, the patient developed severe hemorrhagic gastropathy. Further research into potential therapies and establishment of official management guidelines could potentially help prevent unfavorable outcomes in these patients.


Disclosures:


Simran Bhatti, MD¹, Ruchi Mangal, BS², Chad Barnhart, MD¹. E0332 - Radiation-Induced Refractory Hemorrhagic Gastropathy Resulting in Transfusion Dependence, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.