Gastrointestinal tract injuries after thermal ablative therapies for hepatocellular carcinoma: A case report and review of the literature

Table 1 Studies reporting gastrointestinal tract injuries after thermal ablation therapies for hepatocellular carcinoma

Ref.	Study design	Number of patients	Overall complication rate(%)	GIT injury rate (%)	Type of GIT injury	Thermoablative treatment	Timing of GIT injury	Management of GIT injury	Outcome	Associated conditions
Livraghi et al[29], 2003	Multicentre, retrospective, questionnaire-based1	2320	7.1 (2.42)	0.72	5 colonic perforations; 1 jejunal perforation; 1 gastric perforation	Percutaneous RFA	2 d-4 d	Surgery (7/7)	2 deaths after colonic perforation	Gut wall distance < 1 cm (7/7); adherence due to previous abdominal surgery or inflammatory chronic cholecystitis (6/7); large superficial HCC in left lobe + aggressive treatment (1/7)
De Baere et al[31], 2003	Multicentre, prospective1	312	12 (5.72)	0.32	1 colonic perforation	RFA3	4 d	Surgery	Death	NA
Curley et al[57], 2004	Multicentre, prospective1	608	9.5	0.162	1 stomach wall necrosis	Open RFA	Immediate	Surgery	Recovery	Left lobe
Jansen et al[58], 2005	Multicentre, prospective1	122	9.8 (6.32)	2.5 (02)	2 transient paralitic ileus	RFA3	NA	Spontaneous resolution (2/2)	Recovery	NA
Casaril et al[32], 2007	Single-centre, retrospective1	83	25 (7.22)	0.72	1 colonic perforation	Percutaneous RFA	36 d	NA	Death	Superficial HCC in Sg4; Child-Pugh B
Kasugai et al[22], 2007	Multicentre, retrospective, questionnaire-based	2614	7.92	0.22	1 duodenum injury; 1 stomach injury; 1 colonic perforation	RFA3	NA	External drainage (1/3)	Recovery	NA
Chen et al[34], 2008	Single-centre, retrospective1	104	5.22	0.62	1 colonic peroration with fistula and abscess	Percutaneous RFA	3 wk	External drainage	Recovery	Superficial HCC in Sg4; previous surgery for Denver shunt
Liang et al[30], 2009	Single-centre, retrospective1	1136	2.62	0.22	2 colonic perforations	Percutaneous MWA	3 d-5 d	Surgery (2/2)	Recovery	HCC located < 1 cm from colonic wall + prior right partial hepatectomy (2/2)
Livraghi et al[33], 2012	Multicentre, retrospective, questionnaire-based1	736	10.2 (2.92)	0.22	1 ileal perforation; 1 colonic perforation	Percutaneous MWA	NA	Surgery (2/2)	Recovery	Superficial HCC in Sg4 + abdominal adhesions (2/2)
Koda et al[53], 2012	Multicentre, retrospective, questionnaire-based	13283	3.52	0.05(0.042)	1 colonic perforation; 3 stomach injuries; 2 duodenum injuries	RFA3	NA	Surgery (3/6)	1 Death after colonic perforation	NA
Ding et al[19], 2013	Single-centre, retrospective1	879	8.8-9.4 (3.1-3.52)	0.32	1 bowel perforation	Percutaneous RFA	Immediate	External drainage	Recovery	Previous Whipple procedure
Park et al[54], 2017	Single-centre, retrospective	1211	6.8 (22)	0.22	1 colonic perforation	Percutaneous RFA	NA	NA	Recovery	NA
Jeong et al[28], 2017	Single-centre, retrospective1	3933	NA	1.32 (0.052)	28 stomach injuries; 16 colonic injuries; 6 small bowel injuries; 1 small bowel perforation; 1 colonic perforation	Percutaneous RFA	2 d-13 d (perforations)	Surgery (2/2 perforations)	Recovery	Subcapsular HCC (47/52); previous percutaneous treatments (7/52) or abdominal surgery (19/52)
Maeda et al[59], 2020	Multicentre, retrospective, questionnaire based	9411	3.52	0.042	2 colonic perforations	NA	NA	NA	1 Death	NA

¹HCC and other liver tumors included;

²Major complications;

³Route approach not specified. GIT: Gastrointestinal tract; HCC: Hepatocellular carcinoma; RFA: Radiofrequency ablation; MWA: Microwave ablation; NA: Not available.