Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Gastric cancer presenting with ramucirumab-related gastrocolic fistula successfully managed by colonic stenting: a case report

  • Hiroki Fukuya (Department of Gastroenterology, National Hospital Organization Kyushu Medical Center) ;
  • Yoichiro Iboshi (Department of Gastroenterology, National Hospital Organization Kyushu Medical Center) ;
  • Masafumi Wada (Department of Gastroenterology, National Hospital Organization Kyushu Medical Center) ;
  • Yorinobu Sumida (Department of Gastroenterology, National Hospital Organization Kyushu Medical Center) ;
  • Naohiko Harada (Department of Gastroenterology, National Hospital Organization Kyushu Medical Center) ;
  • Makoto Nakamuta (Department of Gastroenterology, National Hospital Organization Kyushu Medical Center) ;
  • Hiroyuki Fujii (Department of Gastroenterology and Hepatology, National Hospital Organization Fukuoka Higashi Medical Center) ;
  • Eikichi Ihara (Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University)
  • Received : 2022.04.04
  • Accepted : 2022.10.17
  • Published : 2023.11.30
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Abstract

We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.

Keywords

Acknowledgement

We thank Cathel Kerr, BSc, PhD, and Edanz Group (https://en-author-services.edanz.com/ac) for editing the draft of this manuscript.

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