Evaluation of post-procedure hemorrhage in patients with ascites undergoing treatment of hepatic malignancy with thermal ablation utilizing microwave technology.

Editorial comment: a review on radiofrequency, microwave and high-intensity focused ultrasound ablations for hepatocellular carcinoma with cirrhosis

“…On the contrary, for the issue of bleeding, artificial ascites administration is recommended for lesions adjacent to gastrointestinal structures to allow a safer ablation and added fluid is drained at the end of the procedure, just like a paracentesis is performed at the end of percutaneous liver ablation in patients with ascites. We agree with Sherwani et al that the risk of bleeding is low when performing MWA in patients with ascites given the cauterizing nature of the microwave probe, as long as the operator ensures adequate cautery of the traversed liver parenchyma all the way to the hepatic capsule (15). As for worsening liver function, most literature to date has excluded patients with cirrhosis from percutaneous thermal ablation.…”

Indian Society of Vascular and Interventional Radiology Expert Consensus Statements for Ablation in Hepatocellular Carcinoma: Part I

“…However, there was no extension in the duration of hospital stay. No postprocedure hemorrhage was recorded in 23 sessions of MWA in 19 patients in another study by Sherwani et al 59…”

“…However, various studies have reported the safety of RFA for liver tumors in cases of ascites, where precise tract ablation is performed. 58,59 Doppler US in the presence of ascites can easily and precisely demonstrate the site of bleeding from the liver surface, and additional ablation of this site can then be performed to cauterize the bleeding site. In a study by Cha et al, 19 patients with ascites underwent RFA of HCC.…”

Hepatic Microwave Ablation in Challenging Locations

“…In a retrospective study of 23 hepatic MWA sessions performed in the setting of ascites, there was no evidence of postprocedural hemorrhage. 15 Of note, the tract was cauterized during probe removal in all cases. Thus, ascites should not be considered an absolute contraindication to hepatic MWA.…”