Pang FW, Chen B, Peng DT, He J, Zhao WC, Chen TT, Xie ZG, Deng HH. Massive bleeding from a gastric artery pseudoaneurysm in hepatocellular carcinoma treated with atezolizumab plus bevacizumab: A case report. World J Gastrointest Surg 2023; 15(6): 1232-1239 [PMID: 37405100 DOI: 10.4240/wjgs.v15.i6.1232]
Corresponding Author of This Article
Hai-Hui Deng, MD, Doctor, Department of Interventional Radiology, Shenzhen Traditional Chinese Medicine Hospital, No. 1 Fuhua Road, Futian District, Shenzhen 518033, Guangdong Province, China. dhaihui@163.com
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Oncology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Jun 27, 2023 (publication date) through Oct 31, 2025
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Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Pang FW, Chen B, Peng DT, He J, Zhao WC, Chen TT, Xie ZG, Deng HH. Massive bleeding from a gastric artery pseudoaneurysm in hepatocellular carcinoma treated with atezolizumab plus bevacizumab: A case report. World J Gastrointest Surg 2023; 15(6): 1232-1239 [PMID: 37405100 DOI: 10.4240/wjgs.v15.i6.1232]
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1232-1239 Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1232
Massive bleeding from a gastric artery pseudoaneurysm in hepatocellular carcinoma treated with atezolizumab plus bevacizumab: A case report
Fu-Wen Pang, Bin Chen, De-Ti Peng, Jian He, Wei-Cheng Zhao, Tuan-Tuan Chen, Zong-Gui Xie, Hai-Hui Deng
Fu-Wen Pang, Bin Chen, Jian He, Wei-Cheng Zhao, Tuan-Tuan Chen, Zong-Gui Xie, Hai-Hui Deng, Department of Interventional Radiology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
De-Ti Peng, Department of Hepatology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China
Author contributions: Pang FW and Chen B contributed equally to this work; the treatment plan was designed by Xie ZG and Deng HH; treatment was performed by Pang FW and Deng HH; Pang FW and Chen B wrote the manuscript; Pang FW, Chen B, He J, Zhao WC, and Chen TT participated in data acquisition and manuscript revision; Xie ZG, Peng DT, and Deng HH supervised the study; all authors approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Hui Deng, MD, Doctor, Department of Interventional Radiology, Shenzhen Traditional Chinese Medicine Hospital, No. 1 Fuhua Road, Futian District, Shenzhen 518033, Guangdong Province, China. dhaihui@163.com
Received: January 12, 2023 Peer-review started: January 12, 2023 First decision: January 21, 2023 Revised: January 30, 2023 Accepted: April 19, 2023 Article in press: April 19, 2023 Published online: June 27, 2023 Processing time: 154 Days and 1.1 Hours
Abstract
BACKGROUND
The combination of atezolizumab (ATZ) and bevacizumab (BVZ) was approved as first-line systemic therapy for advanced hepatocellular carcinoma (HCC) owing to its superior rates of response and patient survival. However, ATZ + BVZ is associated with increased risk of upper gastrointestinal (GI) bleeding, including arterial bleeding, which is rare and potentially fatal. We present a case of massive upper GI bleeding from a gastric pseudoaneurysm in a patient with advanced HCC who had been treated with ATZ + BVZ.
CASE SUMMARY
A 67-year-old man presented with severe upper GI bleeding after atezolizumab (ATZ) + bevacizumab (BVZ) therapy for HCC. Endoscopy failed to detect the bleeding site. Digital subtraction angiography revealed a gastric artery pseudoaneurysm and contrast extravasation from the inferior splenic artery and a branch of the left gastric artery. Successful hemostasis was achieved with embolization.
CONCLUSION
HCC patients who have been treated with ATZ + BVZ should be followed for 3 to 6 mo to monitor for development of massive GI bleeding. Diagnosis may require angiography. Embolization is an effective treatment.
Core Tip: Atezolizumab (ATZ) + bevacizumab (BVZ) treatment increases the risk of bleeding in hepatocellular carcinoma (HCC) patients. Gastrointestinal (GI) bleeding is most common and usually arises from esophageal varices. We report a patient with advanced HCC who presented with massive upper GI bleeding from a gastric artery pseudoaneurysm after three cycles of ATZ + BVZ. Gastric artery pseudoaneurysm is rare and often asymptomatic. Mortality is high and emergency endovascular embolization is required. Patients receiving ATZ + BVZ treatment should be followed closely for GI bleeding. Arterial bleeding should be considered when massive GI bleeding occurs. Angiography may be required for diagnosis. Embolization has a role in treatment.
