Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2020; 26(35): 5375-5386
Published online Sep 21, 2020. doi: 10.3748/wjg.v26.i35.5375
Gastrointestinal tract injuries after thermal ablative therapies for hepatocellular carcinoma: A case report and review of the literature
Teresa Marzia Rogger, Andrea Michielan, Sandro Sferrazza, Cecilia Pravadelli, Luisa Moser, Flora Agugiaro, Giovanni Vettori, Sonia Seligmann, Elettra Merola, Marcello Maida, Francesco Antonio Ciarleglio, Alberto Brolese, Giovanni de Pretis
Teresa Marzia Rogger, Andrea Michielan, Sandro Sferrazza, Cecilia Pravadelli, Luisa Moser, Flora Agugiaro, Giovanni Vettori, Sonia Seligmann, Elettra Merola, Giovanni de Pretis, Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
Marcello Maida, Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta, Caltanissetta 93100, Italy
Francesco Antonio Ciarleglio, Alberto Brolese, Department of Surgery, Hepato-biliary Surgery Unit, Santa Chiara Hospital, Trento 38122, Italy
Author contributions: Pravadelli C, Michielan A and Sferrazza S contributed to study concept and design; Rogger TM, Michielan A, Sferrazza S, Pravadelli C, Maida M and Ciarleglio FA contributed to drafting of the manuscript; Moser L, Seligmann S, Vettori G, Agugiaro F and Merola E contributed to critical revision of the manuscript for important intellectual content; Brolese A and de Pretis G contributed to study supervision and final approval.
Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Andrea Michielan, MD, Doctor, Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Largo Medaglie D’Oro 9, Trento 38122, Italy.
Received: June 28, 2020
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.

Keywords: Gastrointestinal tract, Radiofrequency ablation, Hepatocellular carcinoma, Complications, Endoscopy, Over-the-scope clip, Case report

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.