Percutaneous Ethanol Injection Research Articles

Percutaneous ethanol injection for liver metastases.

The liver is affected by two of the most common groups of malignant tumours: primary liver tumours and liver metastases from colorectal carcinoma or other extrahepatic primary cancers. Liver metastases are significantly more common than primary liver cancer, and the reported long-term survival rate after radical surgical treatment is approximately 50%. However, R0 resection (resection for cure) is not feasible in the majority of patients; therefore, other treatments have to be considered. One of these is percutaneous ethanol injection (PEI), which causes dehydration and necrosis of tumour cells, accompanied by small-vessel thrombosis, leading to tumour ischaemia and destruction of the tumour. To assess the beneficial and harmful effects of percutaneous ethanol injection (PEI) compared with no intervention, other ablation methods, or systemic treatments in people with liver metastases. We searched the following databases up to 10 September 2019: the Cochrane Hepato-Biliary Group Controlled Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE Ovid; Embase Ovid; Science Citation Index Expanded; Conference Proceedings Citation Index - Science; Latin American Caribbean Health Sciences Literature (LILACS); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched clinical trials registers such as ClinicalTrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the US Food and Drug Administration (FDA) (17 September 2019). Randomised clinical trials assessing beneficial and harmful effects of percutaneous ethanol injection and its comparators (no intervention, other ablation methods, systemic treatments) for liver metastases. We followed standard methodological procedures as outlined by Cochrane. We extracted information on participant characteristics, interventions, study outcomes, study design, and trial methods. Two review authors performed data extraction and assessed risk of bias independently. We assessed the certainty of evidence by using GRADE. We resolved disagreements by discussion. We identified only one randomised clinical trial comparing percutaneous intratumour ethanol injection (PEI) in addition to transcatheter arterial chemoembolisation (TACE) versus TACE alone. The trial was conducted in China and included 48 trial participants with liver metastases: 25 received PEI plus TACE, and 23 received TACE alone. The trial included 37 male and 11 female participants. Mean participant age was 49.3 years. Sites of primary tumours included colon (27 cases), stomach (12 cases), pancreas (3 cases), lung (3 cases), breast (2 cases), and ovary (1 case). Seven participants had a single tumour, 15 had two tumours, and 26 had three or more tumours in the liver. The bulk diameter of the tumour on average was 3.9 cm, ranging from 1.2 cm to 7.6 cm. Participants were followed for 10 months to 43 months. The trial reported survival data after one, two, and three years. In the PEI + TACE group, 92%, 80%, and 64% of participants survived after one year, two years, and three years; in the TACE alone group, these percentages were 78.3%, 65.2%, and 47.8%, respectively. Upon conversion of these data to mortality rates, the calculated risk ratio (RR) for mortality at last follow-up when PEI plus TACE was compared with TACE alone was 0.69 (95% confidence interval (CI) 0.36 to 1.33; very low-certainty evidence) after three years of follow-up. Local recurrence was 16% in the PEI plus TACE group and 39.1% in the TACE group, resulting in an RR of 0.41 (95% CI 0.15 to 1.15; very low-certainty evidence). Forty-five out of a total of 68 tumours (66.2%) shrunk by at least 25% in the PEI plus TACE group versus 31 out of a total of 64 tumours (48.4%) in the TACE group. Trial authors reported some adverse events but provided very few details. We did not find data on time to mortality, failure to clear liver metastases, recurrence of liver metastases, health-related quality of life, or time to progression of liver metastases. The single included trial did not provide information on funding nor on conflict of interest. Evidence for the effectiveness of PEI plus TACE versus TACE in people with liver metastases is of very low certainty and is based on one small randomised clinical trial at high risk of bias. Currently, it cannot be determined whether adding PEI to TACE makes a difference in comparison to using TACE alone. Evidence for benefits or harms of PEI compared with no intervention, other ablation methods, or systemic treatments is lacking.

Renal Sympathetic Denervation by Image-Guided Percutaneous Ethanol Injection - Histopathologic Characteristics, Efficacy and Safety.

Evaluation of the efficacy and safety of chemical renal denervation by image-guided periarterial ethanol injection in pigs with emphasis on histopathological characteristics. Unilateral renal periarterial ethanol injection under general anesthesia was performed in 16 animals with the contralateral kidney serving as the control. All interventions were performed in an open MRI system under real-time multiplanar guidance. In 10 pigs an ethanol-carbostesin contrast agent mixture was injected with amounts of 5 ml (6 animals, group I) and 10 ml (4 animals, group II). 6pigs (group III) were treated with 10 ml of an ethanol-polyacrylic (2 %) mixture. Four weeks after treatment, all animals underwent MRI including MRA. After euthanasia, macroscopic and histologic examination of the kidneys, renal arteries and periarterial tissue was performed to assess nerve injury and potential side effects. Furthermore, the norepinephrine concentration (RTNEC) in the renal tissue was determined as a surrogate parameter of efficacy. Histologic signs of nerval degeneration with various degrees of severity and circumferential distribution were found in all groups. Injury depths ranged up to 7.6 mm. In groups II and III the nerve count was significantly lower on the treated side. Renal artery stenosis was not observed in any pig. In all pigs of group II treatment resulted in neural degeneration with a mean RTNEC reduction of 53 % (p < 0.02). In groups I and III significant changes in RTNEC were not observed. Image-guided percutaneous periarterial ethanol injection was efficient and safe for renal denervation. The detected variations in histologic outcome underlined the importance of the preclinical optimization of the technique in order to maximize treatment effects in humans. · Renal denervation by percutaneous periarterial ethanol injection is an effective and potentially safe procedure.. · The percutaneous approach is less prone to anatomical and procedural limitations compared to catheter-based procedures.. · The achievable nerve injury depth lies beyond those of current RFA-probes.. · Efficacy depends on amount, concentration, viscosity and periarterial distribution of the ethanol-mixture.. · Establishing an optimal balance between these parameters is mandatory for a maximum treatment effect at minimum risk for sensitive adjacent structures.. · Freyhardt P, Haage P, Walter A et al. Renal Sympathetic Denervation by Image-Guided Percutaneous Ethanol Injection - Histopathologic Characteristics, Efficacy and Safety. Fortschr Röntgenstr 2020; 192: 549 - 560.

Magnetic resonance-guided ablation of liver tumors: A systematic review and pooled analysis.

The purpose of this study is to study the clinical outcomes of different types of magnetic resonance (MR)-guided ablation for the treatment of liver tumors by performing a systematic review and pooled analysis. A comprehensive literature search was performed for clinical trials published from January 1997 to October 2019 in PubMed, the Web of Science, Embase, and the Cochrane Library. Pooled analyses were performed to obtain the complete ablation (CA), complication, progression-free survival (PFS), and overall survival (OS) rates. Thirty studies were eligible, including four studies on MR-guided microwave ablation (MWA); 14 studies on MR-guided radiofrequency ablation (RFA); one study on both MR-guided MWA and RFA; eight studies on MR-guided, laser-induced thermotherapy (LITT); two studies on MR-guided percutaneous cryoablation (PC); and one study on MR-guided percutaneous ethanol injection (PEI). The CA rates in patients who underwent RFA, MWA, LITT, PC, and PEI were 95.60%, 98.86%, 77.78%, 47.92%, and 85.71%, respectively. The most frequent complications were pain (27.66%, 13/47) and postablation syndrome (27.66%, 13/47) in the PC group; pleural effusion (8.11%, 119/1,468) and subcapsular hematoma (2.25%, 33/1,468) in the LITT group; pleural effusion (2.67%, 2/75) in the MWA group; and subcapsular hematoma (4.18%, 20/478) and post-ablation syndrome (2.93%, 14/478) in the RFA group. There were few studies reporting PFS and OS. MR-guided ablation is a practicable alternative treatment for liver tumors, especially MR-guided RFA and MWA, which have high rates of CA and low occurrences of complications.

Evaluation of Combined Transcathter Arterial Chemo Embolization (TACE) with Percutaneous Ethanol Injection (PEI) Vs. (TACE) for Unresectable Hepatocellular Carcinoma

There are many treatment options available for hepatocellular carcinoma (HCC) but the best choices for intermediate and advanced tumors are sometimes a matter of controversies. The aim of the work was to compare the combined Trans-catheter arterial chemoembolization (TACE) with percutaneous ethanol injection (PEI) against the technique of TACE alone in patients with unresectable HCC. The study included fifty patients proved radiologically to have hepatocellular carcinoma (HCC) >5 cm in diameter and were not candidate for surgical resection. The patients were divided into two groups Group 1: Patients underwent single Trans-catheter arterial chemoembolization (TACE) followed by four times of Percutaneous ethanol injection (PEI) every other day. Group 2: Patients underwent repeated Trans-catheter arterial chemoembolization (the frequency of sessions was according to response of the patients). Complete resolution of HCC masses achieved in 60% in group 1 versus 52% in group 2. This complete resolution occurred earlier in group 1 than group 2. Group 1 had lower local recurrence rate than group 2. There was a statistically significant reduction in alpha-feto protein level at 3 months post interventional in group 1 and in both groups at 6 months. There was no significant difference between both groups in overall survival, So combined treatment could help in saving time and resources.

Vascularity-Targeted Percutaneous Ethanol Injection of Toxic Thyroid Adenomas: Outcomes of A Feasibility Study Performed in the USA

Objective: The recommended treatment options for toxic adenoma (TA) in the USA are radioactive iodine ablation and surgical resection, with continued observation for pre-toxic adenoma (PTA). Percutaneous ethanol ablation (PEI) has proven efficacy in the treatment of TA and is widely available in Europe but not in the USA. Methods: Retrospective analysis was performed of all patients who underwent PEI for TA/PTA at the University of Utah, from January 2010 to 2018. Ultrasound-guided PEI, with injections targeting power Doppler-mapped blood vessels within the adenomas, was conducted. Functionality was confirmed using thyroid scintigraphy prior to PEI. Results: Eighteen adults (15 female) underwent PEI. Mean age was 41 ± 13.7 years. Baseline thyroid-stimulating hormone (TSH) was suppressed (0.06 ± 0.09 mU/L), with normal free thyroxine (FT4) 1.43 ± 0.39 ng/dL. Median nodule volume was 5.7 cm3 (interquartile range [IQR], 4.8 to 7.7 cm3). Seventy-eight percent (n = 14) underwent two or less PEI sessions. Median volume of ethanol used was 0.46 mL/mL nodule volume (IQR, 0.3 to 0.6 mL). There was a significant increase in TSH concentrations within the first 3 months after PEI (0.06 ± 0.09 mU/L vs. 1.22 ± 1.88 mU/L; P = .02), with a concomitant significant decrease in FT4 concentrations (1.43 ± 0.39 ng/day vs. 1.13 ± 0.25 ng/day; P<.01). Significant nodular volume reduction was observed following PEI (median 5.7 cm3 [IQR 4.8-7.7 cm3] vs. 2.5 cm3 [IQR 2.0-7.8 cm3]; P<.01). Conclusion: Vascularity-targeted PEI is safe and effective for treating PTA and TA. This unique approach required lower injected alcohol volume and fewer injections for therapeutic success. Abbreviations: ATA = American Thyroid Association; FT4 = free thyroxine; IQR = interquartile range; PD = power Doppler; PEI = percutaneous ethanol injection; PTA = pre-toxic adenoma; RAI = radioactive iodine ablation; RFA = radiofrequency ablation; TA = toxic adenoma; TT3 = total triiodothyronine; US = ultrasound.

Ultrasound-guided-fine-needle Aspiration Drainage and Percutaneous Ethanol Injection for Benign Neck Cysts.

Background:Ultrasound-guided-fine-needle aspiration drainage (US-FNAD) and US-percutaneous ethanol injection (US-PEI) have been widely used in the management of benign neck cysts. However, the long-term results of US-FNAD and US-PEI are not well elucidated.Methods:We retrospectively collated patients under neck US examinations from March 2007 to December 2017 and investigated the recurrence after US-FNAD and US-PEI. Univariate and multivariate Cox regression analyses were used to assess significant risk factors for recurrence after US-FNAD.Results:A total of 1075 patients were recruited, and their age was 50 ± 15 (mean ± standard deviation) years. A total of 862 patients had thyroid cysts, 118 patients had thyroglossal duct cysts (TGDC), twenty patients had branchial cleft cysts, 64 patients had parotid sialocysts, and 11 patients had plunging ranulas. Majority of the patients (97%, 1037/1075) reported significant symptom improvement immediately. However, 38% of the patients had recurrence with a median 3-year follow-up period. In a multivariate Cox regression analysis with adjustment for age and gender, plunging ranula (hazard ratio [HR]: 2.44, 95% confidence interval [CI]: 1.19–4.99) and lateral dimension size ≥ 0.8 cm (HR: 1.32, 95% CI: 1.04–1.67) after US-FNAD were independent risk factors for recurrence. There were 15 male and 19 female patients who received US-PEI therapy after repeated US-FNAD, of whom 23 patients had thyroid cysts, 6 had plunging ranulas, 4 had TGDC, and one had a branchial cleft cyst. The overall success rate was 94% (32/34), with a median follow-up period of 1.6 years. Two recurrent symptomatic patients had plunging ranulas. Some patients stated mild pain (21%, 7/34) and swelling sensation (26%, 9/34) after the injection. No major complications, such as vocal fold paresis or airway compression, were found.Conclusion:US-FNAD is an effective tool in the management of benign neck cysts with a 38% recurrence rate. Plunging ranulas have the highest rate of recurrence after FNAD. US-PEI is effective for most recurrent neck cysts after repeated US-FNAD.

Efficacy of Radiofrequency ablation versus Percutaneous Ethanol Injection in Treating Small HCC Among Cirrhotic/bilharzial Patients

Background and study aim: The incidence of hepatocellular carcinoma (HCC) is rising worldwide being the fifth most common cancer and the third cause of cancer-related mortality. Early detection of HCC is associated with a better outcome. In Egypt and over the last decades, a remarkable rise of HCC was observed in the proportion of chronic liver disease patients. The aim of this study is to compare between Radiofrequency ablation (RF) & Percutaneous Ethanol Injection (PEI) in treating small HCC in cirrhotic /bilharzial patients. Patients and Methods: We divided patients into two groups; Group 1: (n=24) were HCC patients with small focal lesions treated by ethanol injection therapy using 99% sterile alcohol delivered in the lesion through a 21-gauge needle, amount of alcohol not exceeding 10ml every session. Group II: (n=24) were HCC patients with small focal lesions treated by radiofrequency ablation using Leveen Needle Electrode.patients were followed up at 1 and 3 months by abdominal ultrasoungraphy& triphasic CT to assess ablation status. Results: The 2 groups are comparable regarding their baseline. The incidence of HCC ablation by PEI is 87.5% while it was to 91.7% in the radiofrequency ablation group with no relapse after 3 months follow up. In both groups, this difference was not statistically significant. Conclusion: The Efficacy of PEI therapy is not inferior to percutaneous RF ablation in the treatment of small HCC lesions up to 2.5 cm in patients with mixed cirrhosis/bilharzial hepatic fibrosis.

Hepatocellular carcinoma recurrence with portal vein thrombosis and bile duct thrombosis 6 years after percutaneous ethanol injection therapy: A case report

Hepatocellular carcinoma recurrence with portal vein thrombosis and bile duct thrombosis 6 years after percutaneous ethanol injection therapy: A case report

Cone-Beam CT–Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma

PurposeTo evaluate the performance of C-arm computed tomography (CT)–guided chemoembolization in patients with hepatocellular carcinoma (HCC) with serum α-fetoprotein (AFP) level > 20 ng/mL but with no overt tumor on CT and/or magnetic resonance imaging. Materials and MethodsFrom May 2010 to May 2017, 34 patients with HCC (25 men and 9 women; mean age, 59.7 y) who had elevated serum AFP levels (> 20 ng/mL) but no overt tumor on 6-mo imaging studies and had shown complete response (CR) after previous chemoembolization underwent C-arm CT–guided conventional chemoembolization. Three radiologists retrospectively reviewed the imaging studies (preprocedural images, C-arm CT scans, and follow-up images) in consensus, and clinical data including AFP levels were retrospectively obtained. Tumor detection by C-arm CT and treatment response after chemoembolization were assessed. ResultsHCC was imaged at the time of chemoembolization in 24 of 34 patients (70.6%). C-arm CT detected tumors in 25 patients (73.5%); 23 detections were true positives, 2 were false positives, and 1 was a false negative (diaphragm metastasis). Among the 23 patients with true-positive results, the first follow-up enhanced imaging studies showed CR (n = 17), partial response (n = 1), progressive disease (n = 4), and indeterminate status (n = 1; treated by percutaneous ethanol injection). ConclusionsC-arm CT–guided chemoembolization may help to detect and treat recurrent tumors in patients who have shown CR after previous chemoembolization but subsequently, during follow-up surveillance, had serum AFP levels > 20 ng/mL without an overt tumor evident on imaging studies.

Comparative Study between Radiofrequency Ablation Combined with either Percutaneous Ethanol Injection or Percutaneous Acetic Acid Injection in the Management of Hepatocellular Carcinoma.

Background and study aim: Radio-frequency ablation (RFA) has attracted the greatest interest because of its effectiveness and safety. However, complete tumor necrosis rate with RFA for tumors larger than 5 cm is less favorable. Acetic acid, which has the ability to penetrate cells with the property of extracting collagen and dissolving lipids, has a stronger killing effect on hepatocytes than ethanol. The aim of this study was to compare two percutaneous combined therapies, RFA plus percutaneous ethanol injection (PEI) and RFA plus percutaneous acetic acid injection (PAI) in hepatocellular carcinoma (HCC) treatment in patients having single focal lesions more than five and up to seven cm in diameter. Patients and Methods: The patients were selected according to the triphasic CT scanning characteristics of HCC. They were randomly allocated into 2 groups: GI included 30 patients who were candidates for 1 setting of RFA then PEI in the same setting. GII included 30 patients ;they were ablated by 1 setting of RFA with 2 overlaps to decrease the size of the remaining unablated areas, then PAI in the same setting. Results: Evaluation of the response one month later using triphasic CT showed significant better responses in GII compared to GI (83.3% vs 60%) with P value <0.05. The response 3 months later was not changed significantly compared to the response after one month of the procedure (56.7% in GI and 80% in GII) Conclusion: Ablation of inoperable large HCC 5.1-7cm can be done with combined techniques. RFA plus acetic acid was compared to RFA plus ethyl alcohol. Complete ablation was superior when acetic acid was used.

Combined Treatments in Liver Ablations

AbstractPercutaneous ablation is a curative treatment indicated in very early and early hepatocellular carcinoma (HCC). Procedural success remains disappointing in lesions ≥3.0 cm and located in subcapsular and perivascular areas. To overcome these limitations, combination treatments have been proposed. The combination of ablation and transarterial chemoembolization (TACE) is widely adopted in clinical practice and may improve survival, particularly in patients with single nodules 3 to 5 cm in size. However, technical issues and clinical indications are still debated. Radiofrequency ablation (RFA) may also be combined with percutaneous ethanol injection to improve local tumor control; limited data show safety and efficacy of this option. The combination of ablation and systemic treatments is still debated. Intravenous injection of thermosensitive liposomal doxorubicin in association with prolonged RFA is under investigation in patients with single lesions &lt; 7 cm. While there is no indication for the use of systemic drugs (specifically sorafenib) in the adjuvant setting, the observation that RFA is able to activate inflammatory reactions has raised interest in the possibility of combining RFA with the new immuno-oncology drugs, for local and distant tumor control. Thus ablation would no longer be reserved only to early HCC but could be exploited also in more advanced stages.

Long-term efficacy of percutaneous ethanol injection in symptomatic thyroid cysts: Results and protocol proposal

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Appropriate treatment modality for solitary small hepatocellular carcinoma: Radiofrequency ablation vs. resection vs. transplantation?

There has been controversy regarding the first-line treatment modality for the patients who have small solitary hepatocellular carcinoma (HCC); radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI), surgical hepatic resection (HR) and liver transplantation (LT). For selection of treatment modality of HCC, it should be considered of hepatic reservoir function as well as the tumor stage. If the liver function is good enough, HR may be the first choice regardless of the tumor size. However, recent studies comparing RFA with resection showed comparable outcome and similar survival rates. RFA, HR and LT provide good outcome for patients who have small HCCs. RFA would be desired in patients who have below 3.0 cm in size and low alpha-fetoprotein (<200 ng/mL). However, in small HCC with high tumor marker, HR should be considered. Better patient selection for the ‘resection first’ approach and early detection of recurrence can achieve better outcomes of the salvage LT strategy. Another benefit of resection first strategy is that it make possible to do enlist of LT for patients before recurrence at high risk of HCC recurrence after resection on the basis of pathologic aggressiveness, microvascular invasion and/or satellites nodule. They should be applied appropriately according to the tumor size, location, tumor markers and underlying liver parenchymal disease.

OR30-2 Efficacy and Safety of Percutaneous Ethanol Ablation of Parathyroid Adenoma

Introduction: Parathyroidectomy is the standard of care for the treatment of primary hyperparathyroidism (PHP). Patients who are not surgical candidates have limited options of treatment. Percutaneous ethanol injection (PEI) for the treatment of parathyroid adenoma was first introduced in the 1980s. Main safety and efficacy data about PEI of parathyroid adenoma comes from the mayo clinic review publication of the treatment of recurrent primary hyperparathyroidism in patient with MEN1. There is no large review of the treatment of PHP. In our practice, we localize the parathyroid adenoma with ultrasound in preparation for surgery. In addition, non-surgical patients who meet the criteria for treatment of hyperparathyroidism get offered the PEI as an option of treatment. All patients who were treated with PEI had FNA from the parathyroid adenoma and PTH level was measured on the aspirate to confirm the diagnosis. Study design: This is a retrospective longitudinal cohort study of calcium and PTH level in patient with PHP after PEI treatment. All patients with PHP who received PEI treatment between 2013 and 2017 electronic chart was reviewed and data was collected about calcium, PTH level before treatment and after treatment up to one year, also side effect and complication of the procedure was collected. Patient who we do not have the 6 months data we assumed treatment failure Result: Baseline characteristic 60 patients, age 34 to 95, 49 female and 11 male, PTH average 136, calcium average 11.2 Normal calcium was achieved in 39 patients (65%) at 1 week after the PEI and 36 patients (58%) at 6 months, also at 6 months the 26 patients who continued to have elevated calcium 17 of them (65%) had improvement in calcium level after the treatment and it was below 11.2. At one year we did not have lab result for all patients, out of the 36 patients who had normal calcium at 6 months we have the result of 29 patients and they continue to have normal calcium Complications from the procedure: pain in the injection site for a few minutes after injection, 4 patients (6%) had hoarseness that resolved in two weeks in 3 patients and one patient had hoarseness that persisted after one year Conclusion: This is the largest cohort of PHP patients treated with PEI and it showed 58% normalization of calcium after treatment. The main significant complication was recurrent nerve injury which was temporary in most cases

Safe and effective percutaneous ethanol injection therapy of 200 thyroid cysts.

Ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) is a minimally invasive procedure that may be performed as an alternative to surgery for the treatment of recurrent symptomatic thyroid cysts for which simple aspiration failed. The present study aimed at assessing US-PEIT in a large cohort of patients, identifying factors influencing treatment outcome. Retrospective analysis of 193 patients with 200 thyroid cysts who underwent US-PEIT in 2004-2018. The initial median cyst volume was 8.5 mL [5.5-16.0]; median final volume at 12 months after the completion of therapy was 0.5 mL [0.2-1.3]. A Volume Reduction Rate (VRR) of 95.0% [86.7-98.0] was achieved. For successful US-PEIT, relatively small total amount of ethanol was needed, on average corresponding to 20.0% [16.7-28.6] of the initial cyst volume. VRR positively correlated with the initial cyst volume and negatively with the presence of complex cyst. Multiple regression analysis showed the presence of complex cyst as an independent predictor of treatment efficacy. US-PEIT of thyroid cysts of all sizes was very successful with using total amounts of ethanol, corresponding to ≈20% of the initial cyst volume.

Efficacy and Safety of Ablative Therapy in the Treatment of Patients with Metastatic Pheochromocytoma and Paraganglioma.

Metastatic pheochromocytoma and paraganglioma (PPGL) are incurable neuroendocrine tumors. The goals of treatment include palliating symptoms and reducing tumor burden. Little is known about the use of radiofrequency ablation (RFA), cryoablation (CRYO), and percutaneous ethanol injection (PEI) to treat metastatic PPGL. We performed a retrospective study of patients age 17 years and older with metastatic PPGL who were treated with ablative therapy at Mayo Clinic, USA, between June 14, 1999 and November 14, 2017. Our outcomes measures were radiographic response, procedure-related complications, and symptomatic improvement. Thirty-one patients with metastatic PPGL had 123 lesions treated during 42 RFA, 23 CRYO, and 4 PEI procedures. The median duration of follow-up was 60 months (range, 0–163 months) for non-deceased patients. Radiographic local control was achieved in 69/80 (86%) lesions. Improvement in metastasis-related pain or symptoms of catecholamine excess was achieved in 12/13 (92%) procedures. Thirty-three (67%) procedures had no known complications. Clavien-Dindo Grade I, II, IV, and V complications occurred after 7 (14%), 7 (14%), 1 (2%), and 1 (2%) of the procedures, respectively. In patients with metastatic PPGL, ablative therapy can effectively achieve local control and palliate symptoms.

Characteristics and survival of hepatocellular carcinoma in non-cirrhotic liver.

the characteristics, screening, and survival of hepatocellular carcinoma (HCC) for patients without cirrhosis have not been fully studied. A retrospective cohort study was performed in non-cirrhotic patients with histological HCC, between January 2004 and October 2018. Their characteristics, treatment, follow-up and overall survival were described. 25 of the 332 patients with HCC met the inclusion criteria (7.5%), 76% were males and the median age was 69.9 years. The main etiology of liver disease was the hepatitis B virus (HBV) (32%), followed by non-alcoholic steatohepatitis (NASH) (20%). Liver fibrosis was mild (0-1) in 44% of cases. The nodule was diagnosed by ultrasonography in 32% of cases, 60% were found incidentally and 8% due to clinical symptoms. The Barcelona Clinic Liver Cancer (BCLC) staging was 0 in 4% of cases, A in 88%, B in 4% and C in 4%. The main initial treatment was surgical resection (76%) and 8% refused to be treated. Percutaneous ethanol injection, chemoembolization, sorafenib and palliative care were each performed in 4% of cases. There were some complications in 21% of patients treated with surgery, half of them were severe. The median follow-up was 22.2 (2.9-150.6) months and 56% were in remission and the median overall survival was 57.4 ± 29.8 months. The overall cumulative survival at 1, 3 and 5 years was 84%, 61.6% and 47.9%, respectively. 7.5% of HCC presented without cirrhosis and almost half of patients had mild fibrosis. HBV was the main cause of HCC, followed by NASH. The most frequent BCLC stage at diagnosis was early stage and surgery was the most common treatment. Overall cumulative survival at 5 years was almost 50%.

An Infected Liver Cyst Treated with Combination of Percutaneous Transhepatic Abscess Drainage and Ethanol Injections: A Case Report

An Infected Liver Cyst Treated with Combination of Percutaneous Transhepatic Abscess Drainage and Ethanol Injections: A Case Report

Effectiveness of Percutaneous Ethanol Injection Therapy Compared to Parathyroidectomy in the Management of Secondary and Tertiary Hyperparathyroidism

Background: Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are a common complication of chronic renal failure. Percutaneous ethanol injection therapy (PEIT) has been used as alternative to surgery, but its effectiveness is inconsistent. Objectives: The objective of the study is to evaluate the effectiveness of PEIT in the management of patients with SHPT and THPT. Materials and Methods: Ninety-one patients with chronic renal failure and SHPT or THPT were treated with PEIT (n = 55) and surgery (n = 36) between January 2006 and July 2015. The medical records, imaging studies, and ablation techniques were reviewed to assess the efficacy of each treatment modality and complications. Results: Parathyroid hormone (PTH) level after treatment &lt;160 pg/mL was used to indicate success of treatment. PEIT showed lower effectiveness compared to surgery (1.8% vs. 61.1%). There was no complication in PEIT group. Symptomatic hypocalcemia was found 11.1% in surgery group. Conclusion: PEIT in treatment of secondary and THPT was much less effective than surgery due to large nodule sizes, high levels of PTH, and multiple parathyroid nodules.

Effectiveness of Percutaneous Ethanol Injection in Nodular Diseases of the Thyroid Gland: 10-Year Follow-Up

ABSTRACT Objective: Percutaneous ethanol injection (PEI) of thyroid cysts is not considered to be the standard of care in Kazakhstan, although thyroid nodules are highly prevalent. Patients with cy...