TREN is a safe and effective treatment for WOPN and could be performed safely without EUS guidance in selected cases. Hydrogen peroxide played a major role in reduction of number of sessions and timing. External irrigation of WOPN is not necessary, if adequate debridement could be achieved.

Background and aim: Imaging guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) has become a widely used method over recent years. Tumors close to the diaphragm, gastrointestinal tract, gallbladder, pancreas, hepatic hilum and major bile duct or vessels are generally considered relative contraindications for microwave ablation. This study was conducted to assess the effectiveness and safety of ultrasonography-guided MWA in treating patients with HCC in difficult anatomical sites in comparison to those in conventional sites. Patients and methods: Eighty-eight patients were included and divided into two groups: the study group of 44 with 46 lesions lying <5mm from the diaphragm, hepatic capsule, gall bladder (GB) or large vessel; and the control group of 44 patients with 50 lesions in non-risky sites. Each lesion was ablated using an ultrasound guided microwave probe using a detailed protocol. Results: Most of the patients were males, with a mean age of 57.8 years. In the study group, two patients had lesions adjacent to the GB, twelve were perivascular and 32 were subcapsular. The overall successful ablation rates were 84.8% and 92% in the study and control groups, respectively. Within the study group, ablation rates were 100%, 75% and 87.5% for lesions close to the GB, perivascular lesions and subcapsular lesions, respectively. One patient developed a subcutaneous abscess, with good outcome after proper treatment. Fever, pain and asymptomatic pleural effusion were reported after ablation without statistically significant difference between the groups or among subgroups. In conclusion: MWA for HCC in difficult anatomical sites is as effective and safe as for ordinary sites.

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High-frequency transabdominal ultrasound and ultrasound-guided core biopsy of bowel lesions are potentially safe and effective diagnostic methods in select gastrointestinal lesions whenever conventional endoscopic diagnosis was unsuccessful, thus avoiding unnecessary diagnostic surgical procedures.