Recurrent hepatogastric fistula during lenvatinib therapy for advanced hepatocellular carcinoma managed by over-the-scope clip closure: a case report

DOI Web Site 参考文献35件
  • Miwa Takao
    Department of Gastroenterology, Chuno Kosei Hospital, Japan
  • Kochi Takahiro
    Department of Gastroenterology, Chuno Kosei Hospital, Japan
  • Watanabe Keitaro
    Department of Gastroenterology, Chuno Kosei Hospital, Japan
  • Hanai Tatsunori
    Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Japan
  • Imai Kenji
    Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan
  • Suetsugu Atsushi
    Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan
  • Takai Koji
    Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Japan
  • Shiraki Makoto
    Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan
  • Katsumura Naoki
    Department of Gastroenterology, Chuno Kosei Hospital, Japan
  • Shimizu Masahito
    Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan

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<p>Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).</p><p>Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.</p><p>Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.</p><p>Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.</p>

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