Percutaneous ethanol injection for the treatment of hepatic tumors: indications, mechanism of action, technique, and efficacy.

Lee, M J; Müeller, Peter R.; Dawson, Steven L.; Gazelle, S G; Hahn, Peter F.; Goldberg, M A; Boland, Giles W.

doi:10.2214/ajr.164.1.7998542

Cited by 78 publications

(33 citation statements)

References 22 publications

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“…It is especially suitable for foci that could be clearly detected on ultrasound [29] . For the CT-guided PEI, it is a key step to insert the needle accurately into the target.…”

Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Zuo¹,

Wang²,

Shao³

et al. 2004

WJG

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AIM:To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes. METHODS:CT-guided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and stylet, a disposable curved tip (25 G) and a fine stylet. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors, multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curved needle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle. RESULTS:All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRI) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors, respectively. Among the 8 tumors sizing up to 5 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases. In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3 times of PEI, all the foci treated were completely necrotic and smaller demonstrated by dynamic contrast-enhanced CT or MRI 3 months later.CONCLUSION: CT-guided PEI using a disposable curved needle is effective, time-saving and convenient, providing an alternative therapy for the treatment of malignant liver tumors and their retroperitoneal lymph node metastases.Zuo CJ, Wang PJ, Shao CW, Wang MJ, Tian JM, Xiao Y, Ren FY, Hao XY, Yuan M. CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes.

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“…It is especially suitable for foci that could be clearly detected on ultrasound [29] . For the CT-guided PEI, it is a key step to insert the needle accurately into the target.…”

Section: Discussionmentioning

confidence: 99%

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Zuo¹,

Wang²,

Shao³

et al. 2004

WJG

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“…In experienced hands, the morbidity rate is low and quality of life is good. In addition to these drainage procedures, other treatment modalities were applied with some success for local elimination or inhibition of the tumour growth [6, 7]. However, the biological behavior of the HCC differs essentially from metastatic liver tumours.…”

Section: Discussionmentioning

confidence: 99%

“…Obstructive jaundice due to mechanical tumour obstruction of the biliary tree, however, is only rarely caused by HCC. As for other hilar obstructions, there exist various possibilities for treatment: surgical excision in curative or palliative attempt, a variety of surgical biliodigestive bypass procedures [2, 3], interventional radiological [4]and endoscopical [5]insertion of an endoluminal prosthesis in order to bypass the obstruction, percutaneous injection of ethanol to reduce the size of the tumour [6, 7]and transcatheter arterial embolization (TAE) with different agents including radionuclide embolization with yttrium-90 [8, 9, 10]. …”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Approach to Palliation of Obstructive Jaundice Caused by a Central Hepatocellular Carcinoma

Läuffer¹,

Mai²,

Berchtold³

et al. 1999

Dig Surg

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Background/Aims: Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC). Methods: We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. Cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before. Results: With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved. Conclusion: The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.

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“…Ethanol injection causes dehydration and intracellular coagulation, which leads to ne crosisand,ultimately,vascularocclusionand fibrosis. Recent studies showed that percuta neousethanolinjectiontherapyappearsto be effective for a limited number of small tu mors less than 3â€"S cm in diameter and that the 3-year survival rate with this therapy was similar to that of surgery [2]. We have treated large nodules with this procedure for the past 10 years, realizing it is important to insert multiple needles because ethanol may not diffuse evenly through large tumors, leaving some areas unaffected [3].…”

Section: Masatoshiimamura1mentioning

confidence: 98%

Percutaneous hepatic infarction therapy for hepatocellular carcinoma.

Imamura¹,

Shiratori²,

Sato³

et al. 1998

American Journal of Roentgenology

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Percutaneous ethanol injection for the treatment of hepatic tumors: indications, mechanism of action, technique, and efficacy.

Cited by 78 publications

References 22 publications

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

Multidisciplinary Approach to Palliation of Obstructive Jaundice Caused by a Central Hepatocellular Carcinoma

Percutaneous hepatic infarction therapy for hepatocellular carcinoma.

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