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

Takao Miwa; Takahiro Kochi; Keitaro Watanabe; Tatsunori Hanai; Kenji Imai; Atsushi Suetsugu; Koji Takai; Makoto Shiraki; Naoki Katsumura; Masahito Shimizu

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

VernacularTitle:Recurrent hepatogastric fistula during lenvatinib therapy for advanced hepatocellular carcinoma managed by over-the-scope clip closure: a case report
Author: Takao MIWA ¹ ; Takahiro KOCHI ¹ ; Keitaro WATANABE ¹ ; Tatsunori HANAI ² ; Kenji IMAI ³ ; Atsushi SUETSUGU ² ; Koji TAKAI ² ; Makoto SHIRAKI ² ; Naoki KATSUMURA ³ ; Masahito SHIMIZU ²
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1. Department of Gastroenterology, Chuno Kosei Hospital, Japan
2. Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Japan
3. Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Japan
Keywords: fistula; hepatocellular carcinoma; lenvatinib; over-the-scope clip; tyrosine kinase inhibitor
From:Journal of Rural Medicine 2021;16(2):102-110
CountryJapan
Language:English
Abstract: 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).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.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.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.