EUS-guided Nd:YAG laser ablation of a hepatocellular carcinoma in the caudate lobe

A 71-year-old female was diagnosed with hepatocellular carcinoma (HCC). The tumor measured 65 mm in diameter and was located in the caudate lobe. Transarterial chemoembolization (TACE) was performed repeatedly; however, a follow-up dynamic computed tomography (CT) scan showed that the tumor remained viable. Thus, TACE was performed using drug-eluting beads that had been preloaded with epirubicin. Contrast-enhanced endoscopic ultrasonography (CE-EUS) was conducted for evaluating the treatment effects. First, we detected the internal part of the tumor. Then, a perflubutane suspension was injected intravenously. Next, CE-EUS was performed for the external ventral part of the tumor in the same manner. The perflubutane flowed into the tumor and spread into both its internal and external ventral regions. Thus, we considered that the tumor was still viable and planned to carry out TACE again. CE-EUS could be a useful tool for evaluating the treatment effects of TACE on HCC deep inside the liver.

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“…In addition, several cases in which EUS was used to guide ablative liver tumor therapy or abscess drainage have been reported. [8910]…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the viability of hepatocellular carcinoma in the caudate lobe using contrast-enhanced endoscopic ultrasonography after transarterial chemoembolization

Nakaji

Hirata

2016

Endosc Ultrasound

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“…Several case reports have shown the possible role of EUS in the treatment of patients with HCC lesions that are difficult to be accessed by the traditional percutaneous methods. [103][104][105] In the first case report, neodymium-doped yttrium aluminum garnet (Nd:YAG) laser ablation of a lesion in the caudate liver lobe was successfully accomplished, 103 while in the other two case reports ethanol ablation of difficult-to-treat HCCs was performed. 104,105 More recently, Nakaji et al 106 reported their long-term experience with EUS-guided ethanol ablation in 12 patients with early-stage HCC.…”

Section: Eus For Evaluation and Treatment Of Solid Liver Lesionsmentioning

confidence: 99%

Endoscopic Ultrasound for the Hepatologist: A Comprehensive Review

et al. 2018

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In the last few years, the diagnostic and therapeutic utilization of endoscopic ultrasound (EUS) for a variety of liver conditions has exponentially grown. We performed a thorough search for all available studies on the performance of diagnostic and therapeutic EUS in the field of hepatology. This article reviews the indication of EUS in the evaluation and treatment of portal hypertension, portal vein pressure measurement, focal liver lesions, and parenchymal liver diseases, and presents all the clinical evidences available so far in this regard. All the review data suggest that EUS is becoming an increasingly important tool in the armamentarium of the hepatologists for the management of certain liver-related conditions. Implementation in the education of the hepatologists of means to become more familiar with both diagnostic and therapeutic capabilities of EUS is warranted.

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“…36,37 EUS-guided interventions on nonpancreatic malignancies, including esophageal and hepatocellular carcinoma and metastatic lymph nodes, have also been reported. 38,39 All EUS-guided treatment of neoplasia remains investigational, and best indications and techniques have not been established.…”

Section: Guidewire Rendezvous (Eus-guided Rendezvous [Eus-rv]mentioning

confidence: 99%