S3116 Gastric Distention With Gastroparesis: An Uncommon Side Effect of Chemotherapy

Introduction: Chemotherapy-induced adverse effects are common, especially in the gastrointestinal (GI)tract. The most common side effects are nausea, vomiting, belching, diarrhea, and constipation. We present a case of gastric distention with gastroparesis(GP) as an uncommon side effect from capecitabine(CB) use. Case Description/Methods: An 85 yr old lady with a past medical history of hypertension and a recent diagnosis of stage II squamous cell carcinoma of anal canal. She had received CB as part of her chemotherapy. She presented to the hospital with complaints of generalized weakness, rectal pain, and diarrhea. The patient also stated that she has abdominal pain with distention especially with oral intake and weight loss. She was initially treated for acute kidney injury and oral thrush with intravenous fluids and oral nystatin. CT- imaging of the chest abdomen showed a severely distended stomach with a patulous fluid-filled esophagus suggestive of a gastric outlet obstruction(Fig 1). Gastroenterology reviewed and subsequently had EGD, which revealed severe esophagitis with fluid retention in the esophagus. The stomach was hugely distended with fluid debris. The pyloric canal opening was patent and adult scope was easily traversed into the duodenum. After excluding other causes of GP such as diabetes, gastric surgery, infections, and scleroderma, the most likely cause of her gastric distention was thought to be due to GP secondary to CB use. She was given a trial of metoclopramide and after discussion with oncology, CB was discontinued. The patient's symptoms improved and discharged home. Discussion: Gastroparesis a motility disorder, etiology broadly divided into neurogenic causes such as diabetes, post- GI surgery, multiple sclerosis, myogenic causes such as polymyositis, amyloidosis, and other causes including GI viral infections, certain medications, and radiation therapy. The CB is an oral antimetabolite chemo agent converted into active form fluorouracil, which inhibits DNA synthesis and disrupts the processing of RNA. In our case, the patient's symptoms of GP were probably due to the damage of the visceral autonomic nervous system leading to visceral neuropathy from CB use. Gastric dysmotility is a rare occurrence with CB use. GP has debilitating effects on patient's quality of life. Careful monitoring for any such symptoms is recommended for early recognition and treatment of GP, especially in patients who were being treated with CB chemotherapy.Figure 1.: Endoscopic image shows the gastrostomy tube balloon tip causing gastric outlet obstruction.