Hyaluronic Acid Gel Injection to Prevent Thermal Injury of Adjacent Gastrointestinal Tract during Percutaneous Liver Radiofrequency Ablation

Abstract

This study evaluated the safety, feasibility, and clinical utility of hyaluronic acid gel injection to separate the gastrointestinal tract from the tumor during liver radiofrequency ablation (RFA). Eleven patients with liver tumors measuring 0.9-3.5 cm (mean ± standard deviation, 2.1 ± 0.8 cm) that were adjacent to the gastrointestinal tracts received RFA after the mixture of hyaluronic acid gel and contrast material (volume, 26.4 ± 14.5 mL; range, 10-60 mL) was injected between the tumor and the gastrointestinal tract under computed tomographic-fluoroscopic guidance. Each tumor was separated from the gastrointestinal tract by 1.0-1.5 cm (distance, 1.2 ± 0.2 cm) after injection of hyaluronic acid gel, and subsequent RFA was performed without any complications in all patients. Although tumor enhancement disappeared in all patients, local tumor progression was found in a patient (9.1%, 1 of 11) during the follow-up of 5.5 ± 3.2 months (range, 0.4-9.9 months). In conclusion, hyaluronic acid gel injection is a safe and useful technique to avoid thermal injury of the adjacent gastrointestinal tract during liver RFA.

Percutaneous radio-frequency ablation of hepatocellular carcinoma adjacent to the gastrointestinal tract

“…Although the size of tumours in the study group showed no significant difference from that in the control group, tumours in the study group required a longer duration of ablation than those in the control group because of intermittent emission of radio-frequency electrodes to avoid thermal damage to adjacent bowel loops. The results of the study were similar to previous reports of thermal ablation for such tumours with other adjuvant techniques, such as artificial ascites and hyaluronic acid gel injection between the tumour and gastrointestinal tract [30,[32][33]. However, the number of treatment sessions was not increased in our study, which profited from detailed treatment protocol design and accurate placement of electrodes, tissue thermal monitoring needles and ethanol injection needles.…”

“…Some authors have recommended that percutaneous thermal ablation should be avoided when treating liver tumours adjacent to the gastrointestinal tract [25]. Some authors reported that for treating such tumours, special interventional techniques such as introducing artificial ascites and hyaluronic acid gel injection are necessary to separate the gastrointestinal tract from the liver [29][30][31][32][33]. However, there are certain factors that result in poor visibility of the puncture needle on ultrasound (US), which increases the difficulty of insertion and the occurrence of complications such as intraperitoneal bleeding, intestinal perforation and peritoneal seeding [30].…”

Microwave ablation in primary and secondary liver tumours: technical and clinical approaches

“…Hyaluronic acid, packaged as a highly viscous gel, has been used to separate bowel from the liver surface during ablation to prevent more superficial liver ablations (63). Thermo-reversible polaxamer gels, designed to increase in viscosity at high temperatures, have shown promising results in pre-clinical studies (64).…”

Fibrillar collagen injection for organ protection during thermal ablation of hepatic malignancies

“…that the instillation of fluid separated the liver from the gastrointestinal tract in 78% of cases (4,5). Most recently, reports have emerged using a hyaluronic acid gel in humans and thermoprotective gels in an animal model (7,8). Fibrillar collagen is an absorbable bovine collagen hemostatic agent, which is available in fibrillar and pad forms.…”