Published online Sep 21, 2020. doi: 10.3748/wjg.v26.i35.5375
Peer-review started: June 28, 2020
First decision: July 28, 2020
Revised: August 11, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: September 21, 2020
Radiofrequency ablation (RFA) and microwave ablation (MWA) represent the standard of care for patients with early hepatocellular carcinoma (HCC) who are unfit for surgery. The incidence of reported adverse events is low, ranging from 2.4% to 13.1% for RFA and from 2.6% to 7.5% for MWA. Gastrointestinal tract (GIT) injury is even more infrequent (0.11%), but usually requires surgery with an unfavourable prognosis. Due to its low incidence and the retrospective nature of the studies, the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics, comorbidities and treatment approaches.
A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location. He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever. A subcutaneous abscess was diagnosed and treated by percutaneous drainage. A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall. The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulent abdominal collection. An over-the-scope clip (OTSC) was used to successfully close the defect
This is the first reported case of RFA-related GIT injury to have been successfully treated with an OTSC, which highlights the role of this endoscopic treatment for the management of this complication.
Core Tip: Thermal ablative therapies have a key role in the treatment algorithm for hepatocellular carcinoma, and besides their efficacy and tolerability, several studies have proven their overall safety. Nevertheless, albeit rarely, a number of complications have been reported and awareness is crucial to proposing the best treatment for each patient. We report the unusual case of a gastric perforation that was treated in our division and how it was managed with an endoscopic over-the-scope clip for the first time. The literature review aims to discuss the most relevant published data on gastrointestinal tract injuries after thermal ablation therapies.