Clinical outcomes of endoscopic ultrasound-guided ethanol injection for hepatocellular carcinoma in the caudate lobe

Background and study aims: Accurately puncturing hepatocellular carcinomas (HCC) that arise from the caudate lobe is generally considered to be technically difficult. We conducted a retrospective study to evaluate the feasibility and safety (the therapeutic outcomes and adverse events) of endoscopic ultrasound (EUS)-guided ethanol injection as a novel treatment for HCC in the caudate lobe.

Patients and methods: Twelve patients with early-stage HCC of the caudate lobe that were treated with EUS-guided ethanol injection at two tertiary referral centers were reviewed retrospectively. To evaluate the therapeutic effect of the treatment, a local control curve and an overall survival curve were constructed using the Kaplan–Meier method.

Results: The mean follow-up duration was 31.0 months. The 1-year local control rate was 80.2 %, and recurrent lesions developed in 2 cases (after 3 and 9 months, respectively). The overall survival rate was 91.7 %, 75.0 %, and 53.3 % at 1, 2, and 3 years, respectively. Concerning procedure-related adverse events (AEs), 2 patients suffered episodes of fever lasting a few days; however, no serious AEs occurred.

Conclusions: EUS-guided ethanol injection could be a useful treatment for early-stage HCC in the caudate lobe because of its simplicity and reduced invasiveness.

• References

• 1 Tanaka S, Shimada M, Shirabe K et al. Surgical outcome of patients with hepatocellular carcinoma originating in the caudate lobe. Am J Surg 2005; 190: 451-455
• 2 Kanda Y. Investigation of the freely available easy-to-use software ‛EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452-458
• 3 Kim HC, Chung JW, Jae HJ et al. Caudate lobe hepatocellular carcinoma treated with selective chemoembolization. Radiology 2010; 257: 278-287
• 4 Hatanaka T, Kakizaki S, Yuhei S et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma located in the caudate lobe of the liver. Acta Gastroenterol Belg 2015; 78: 267-273
• 5 Nishigaki Y, Tomita E, Hayashi H et al. Efficacy and safety of radiofrequency ablation for hepatocellular carcinoma in the caudate lobe of the liver. Hepatol Res 2013; 43: 467-474
• 6 Kariyama K, Nouso K, Wakuta A et al. Percutaneous radiofrequency ablation for treatment of hepatocellular carcinoma in the caudate lobe. Am J Roentgenol 2011; 197: W571-575
• 7 Jiang K, Zhang W, Su M et al. Laparoscopic radiofrequency ablation of solitary small hepatocellular carcinoma in the caudate lobe. Eur J Surg Oncol 2013; 39: 1236-1242
• 8 Fu Y, Zhao X, Yun Q et al. Transarterial chemoembolization (TACE) plus percutaneous ethanol injection (PEI) for the treatment of unresectable hepatocellular carcinoma: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2015; 8: 10388-10400
• 9 Gunter E, Lingenfelser T, Eitelbach F et al. EUS-guided ethanol injection for treatment of a GI stromal tumor. Gastrointest Endosc 2003; 57: 113-115
• 10 Jurgensen C, Schuppan D, Neser F et al. EUS-guided alcohol ablation of an insulinoma. Gastrointest Endosc 2006; 63: 1059-1062
• 11 Sun S, Xu H, Xin J et al. Endoscopic ultrasound-guided interstitial brachytherapy of unresectable pancreatic cancer: results of a pilot trial. Endoscopy 2006; 38: 399-403
• 12 Di Matteo F, Grasso R, Pacella CM et al. EUS-guided Nd:YAG laser ablation of a hepatocellular carcinoma in the caudate lobe. Gastrointest Endosc 2011; 73: 632-636
• 13 Nakaji S, Hirata N, Iwaki K et al. Endoscopic ultrasound (EUS)-guided ethanol injection for hepatocellular carcinoma difficult to treat with percutaneous local treatment. Endoscopy 2012; 44 (Suppl. 02) E380
• 14 Nakaji S, Hirata N, Kobayashi M et al. Endoscopic ultrasonography-guided ethanol injection as a treatment for ruptured hepatocellular carcinoma in the left hepatic lobe. Endoscopy 2015; 47 (Suppl. 01) E558-560