A Case Series of Radiation-induced Hemorrhagic Gastroduodenitis

OBJECTIVE: We examined the clinical course and treatment method of a case series of radiation-induced hemorrhagic gastroduodenitis with clinical signs. METHODS: This was a single-center retrospective observational study. PATIENTS: We included seven patients with radiation-induced hemorrhagic gastroduodenitis treated at our hospital between April 2014 and May 2020. RESULTS: One male patient each had cancer of the head of the pancreas, bile duct cancer, hepatocellular carcinoma, and ureteral cancer, whereas two women had recurrent endometrial cancer and one woman had recurrent cervical cancer. The onset occurred 3-5 months after the end of radiation treatment. Endoscopic examinations showed a red edematous mucous membrane in a fragile condition stretching from the antrum of the stomach to the duodenum, with telangiectasia and ulcer. For endoscopic hemostasis, five patients underwent argon plasma coagulation (APC), which was successful in three patients. Two of these were being administered an antithrombotic at the time. One case resistant to conservative treatment required repeated transfusion for recurring hemorrhaging over a short period of time and therefore underwent surgical treatment. Thereafter, the postoperative course was favorable. CONCLUSIONS: Actively attempting hemostasis through APC and surgery is effective for treating radiation-induced hemorrhagic gastroduodenitis. The use of an antithrombotic agent might lead to a risk of repeated hemorrhaging. Therefore, repeated hemostasis through APC is crucial.