S6480 Refractory Gastric Bleeding From Y-90 Radiotherapy in a Patient With Splenic Angiosarcoma

Introduction: Splenic angiosarcoma is rare aggressive vascular neoplasm with a mean survival of 12-24 months after diagnosis. Treatment modalities include resection, chemotherapy, and radiation therapy; each associated with possible complications. Reports of gastrointestinal (GI) bleeding associated with splenic angiosarcomas are rare but can occur in metastasis to the GI tract or side effects of treatment. This report highlights the case of a 73-year-old woman with a large splenic angiosarcoma with refractory gastrointestinal bleeding from radiation gastritis following yttrium-90 (Y-90) radioembolization. Case Description/Methods: Seventy-three-year-old woman with a large splenic angiosarcoma with metastases to the bone, liver, and lungs status-post Y-90 radiotherapy presented to the emergency department with melena and symptomatic anemia for 3 weeks. She was hemodynamically stable with splenomegaly on exam. Labs revealed a hemoglobin of 5.8. Computed tomography (CT) imaging of the abdomen and pelvis revealed a large necrotic mass involving most of the spleen measuring up to 21 cm. Esophagogastroduodenoscopy (EGD) revealed compression of the gastric cardia region from the splenic mass. There was gastric friability and numerous angiectasias in the proximal gastric body and fundus regions which bled upon contact. Treatment was attempted with argon plasma coagulation (APC) and radiofrequency ablation (RFA); each with suboptimal hemostasis. Hemospray was subsequently utilized with immediate hemostasis. Biopsies of the area were negative for dysplasia, but did reveal radiation-induced gastropathy with notable black spheres present in vascular channels; consistent with Y-90 microsphere therapy. Discussion: Y-90 radioembolization utilizes yttrium-labeled microspheres to induce necrosis in malignant lesions such as hepatocellular carcinoma or angiosarcoma. It is a minimally invasive technique but can be associated with various GI complications including emesis, cholecystitis, or even GI bleeding such as in our patient. Y-90 radiotherapy-associated gastric bleeding is a relatively rare complication seen in approximately 2% of patients. Gastric ulceration is the most common etiology and standard endoscopic therapies can be attempted; however, there is no consensus on optimal management. In this patient’s case topical hemostatic therapy (hemospray) was ultimately successful in achieving immediate hemostasis. She is currently under close endoscopic surveillance and clinical monitoring.