Percutaneous Ethanol Injection Therapy (Liver)
The percutaneous ethanol injection therapy (PEI) therapy is a medical procedure for the treatment of hepatocellular carcinoma (hepatocellular carcinoma, HCC). 95% ethanol is injected with a hollow needle into the tumor under ultrasound control , which results in local tissue destruction ( necrosis ).
Percutaneous ethanol injection therapy should not be confused with a special chemotherapy, which consists of cisplatin (P), etoposide (E) and ifosfamide (I) and is used in testicular cancer . Both procedures are abbreviated to “PEI” therapy.
application
The application of percutaneous ethanol injection therapy in hepatocellular carcinoma is carried out with the help of a targeted, sonographically controlled liver puncture . After skin disinfection in the area of the puncture site and sedation (e.g. with propofol ), the tumor is visualized with an ultrasound device and after a targeted puncture with the hollow needle, 1 ml - 200 ml of high-percentage alcohol is injected into the tumor. This is then distributed in the tumor tissue and appears "cloud-like" on ultrasound. It is important to ensure that the peripheral areas of the tumor are also captured.
PEI therapy is usually carried out in several sessions, with up to twelve treatments being carried out. PEI therapy is often combined with other methods (e.g. radio frequency ablation / RFA or transarterial chemoembolization / TACE) or it is used if further tumor foci in the liver could not be removed after surgical resection of a hepatocellular carcinoma. In the vast majority of cases, however, PEI therapy cannot be assumed to result in complete tumor destruction, so it is a palliative treatment method that is intended to reduce tumor growth.
Contraindications
PEI therapy should not be used
- advanced cirrhosis in stage Child-Pugh C
- Distant metastasis
- malignant vascular infiltration
- Obstructive jaundice
- large amounts of ascites
Side effects
A large multicenter study of 1066 HCC patients with 8118 PEI sessions from 1997 showed the following risks and side effects:
- 24% fever as a result
- 14% pain that had to be treated with pain relievers
- 3% temporary deterioration in liver function
- 0.7% metastases in the puncture channel
- 0.5% bleeding into the peritoneum
- 0.09% death (one patient, due to profuse bleeding in the abdomen)
Individual evidence
- ↑ a b W. Caspary, U. Leuschner, S. Zeuzem: treatment of liver and biliary diseases. Springer-Verlag, 2001, ISBN 3-540-67390-3 .
- ↑ M. Di Stasi et al.: Percutaneous ethanol injection in the treatment of hepatocellular carcinoma. In: Scand J Gastroenterol. 32, 1997, pp. 1168-1173.
