Upper Gastrointestinal Bleed Due to Invasive Hepatocellular Carcinoma and Hepato-Gastric Fistula

Abstract

A 69-year-old man with cirrhosis of the liver, possibly secondary to Nonalcoholic Fatty Liver Disease (NAFLD) and multifocal Hepatocellular Carcinoma (HCC) post three sessions of Transcatheter Arterial Chemoembolization (TACE) in the past 8 months presented with Upper Gastrointestinal (UGI) bleed. The last session of TACE was performed two months prior to the presentation. After initial hemodynamic resuscitation an UGI endoscopy was performed which showed a large antral opening at the lesser curvature of the stomach, 3-4 cm proximal to the pylorus with an ulcer at its mouth (Figure 1). The opening led to an obvious track extending distally. Attempts to enter the track were not made due to the high risks involved. The active ooze of blood noted

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

“…The sites of gastrointestinal tract involvement include the stomach, duodenum, jejunum, and colon 5 , 6 , 7 ) . Hepatogastric fistula is a rare complication related to HCC, and is usually observed as a complication of pyogenic and amebic liver abscess 22 ) . Direct invasion and HCC treatment might be the reasons for fistula formation.…”

“…However, patients with HCC are not always good candidates for surgery owing to the advanced stage of HCC and impaired liver functions. For the endoscopic approach, the use of through-the-scope clip closure 22 ) and histoacryl injection 32 ) have been reported. Despite these modes of treatment, gastrointestinal involvement in HCC is reported to have a poor prognosis 5 , 6 ) , and the treatment of hepatogastric fistula remains challenging.…”

Hepatocellular Carcinoma with Gastrointestinal Involvement: A Systematic Review

“…As evidenced by the various aspects described, endoscopic features are not specific and can pose differential diagnosis problems. However, the following aspects should draw suspicion in a patient with HCC: polypoid mass, a submucosal tumor/extrinsic compression, ulcerative lesions or even the presence of a fistula [8,48,50,63,80]. The histopathologic examination is mandatory for a certain diagnosis.…”