EUS-guided RFA of a HCC of the liver
We present here the case of a 75-year-old male patient with HCV-related liver cirrhosis who in May 2015 underwent percutaneous RFA for a HCC carcinoma of the VIII liver segment. The patient was in good clinical condition until June 2017 when a follow-up abdominal MRI was done. On the MRI there was a 25 mm hypovascular lesion of the III liver segment. On multidisciplinary clinical board evaluation, a new percutaneous RFA was not taken into accountbecause of the difficult approach of the III liver segment with this technique. Therefore, EUS-RFA of the lesion was planned.
The procedure was done with an Olympus ultrasound endoscope and EUS-guided 19-gauge 10 mm long RFA needle. The needle has no stylet and is equipped with a specially designed cooling system that decreases the temperature on the active part. After puncturing the lesion with the RFA needle at 30 watts for 3 to 8 seconds monopolar electricity was delivered under direct EUS control directly in the lesion of the III liver segment.Multiple passages with the RFA needle were done until all the area of the lesion has acquired echogenic changes. The time of tissue exposure to electricity and the watts are automatically controlled by the device trough impedenzometry. All that the endoscopist has to do is to puncture multiple timesthe area with the lesion, and every time a puncture is done should only wait for the generator to complete the cycle that consists in impedenzometry calculation and electricity transmission. Here you can see the multiple passages with the RFA needle and the changing in echogenicity of the lesion. No adverse events were observed during the procedure,and the patient was discharged the following day. Abdominal MRI was done 1 month after the procedure, and there was evidence of complete disappearing of the lesion of the III liver segment. Here you can see the MRI before and after ablation. At the follow-up visit the patient was in good clinical conditions. To our knowledge this is a first report of EUS-guided RFA of HCC and the treatment was clinically and technically successful. This treatment could be a good therapeutic option for patients that are not candidates for percutaneous radiofrequency ablation due to a difficult approach. The safety and efficacy of this treatment should be evaluated in larger series since major adverse events as liver abscess, bile leaks and bleedings might occur during the procedure.