This study evaluated the safety, feasibility, and clinical utility of hyaluronic acid gel injection to separate the gastrointestinal tract from the tumor during liver radiofrequency ablation (RFA). Eleven patients with liver tumors measuring 0.9–3.5 cm (mean ± standard deviation, 2.1 ± 0.8 cm) that were adjacent to the gastrointestinal tracts received RFA after the mixture of hyaluronic acid gel and contrast material (volume, 26.4 ± 14.5 mL; range, 10–60 mL) was injected between the tumor and the gastrointestinal tract under computed tomographic–fluoroscopic guidance. Each tumor was separated from the gastrointestinal tract by 1.0–1.5 cm (distance, 1.2 ± 0.2 cm) after injection of hyaluronic acid gel, and subsequent RFA was performed without any complications in all patients. Although tumor enhancement disappeared in all patients, local tumor progression was found in a patient (9.1 %, 1 of 11) during the follow-up of 5.5 ± 3.2 months (range, 0.4–9.9 months). In conclusion, hyaluronic acid gel injection is a safe and useful technique to avoid thermal injury of the adjacent gastrointestinal tract during liver RFA.
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Conflict of interest
The authors declare that they have no conflict of interest.
Livraghi T, Goldberg SN, Lazzaroni S (1999) Small hepatocellular carcinoma: treatment with radiofrequency ablation versus ethanol injection. Radiology 210:655–661PubMedGoogle Scholar
Livraghi T, Solbiati L, Meloni MF et al (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226:441–451PubMedCrossRefGoogle Scholar
Rhim H, Yoon KH, Lee JM et al (2003) Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics 23:123–134PubMedCrossRefGoogle Scholar
Park SY, Tak WY, Jeon SW et al (2010) The efficacy of intraperitoneal saline infusion for percutaneous radiofrequency ablation for hepatocellular carcinoma. Eur J Radiol 74:536–540PubMedCrossRefGoogle Scholar
Kariya S, Tanigawa N, Kojima H et al (2005) Radiofrequency ablation combined with CO2 injection for treatment of retroperitoneal tumor: protecting surrounding organs against thermal injury. AJR Am J Roentgenol 185:890–893PubMedCrossRefGoogle Scholar
Yamakado K, Nakatsuka A, Akeboshi M et al (2003) Percutaneous radiofrequency ablation of liver neoplasms adjacent to the gastrointestinal tract after balloon catheter interposition. J Vasc Interv Radiol 14(9 pt 1):1183–1186PubMedCrossRefGoogle Scholar
Fraser JR, Laurent TC, Laurent UB (1997) Hyaluronan: its nature, distribution, functions and turnover. J Intern Med 242:27–33PubMedCrossRefGoogle Scholar
Prada PJ, Fernández J, Martinez AA et al (2007) Transperineal injection of hyaluronic acid in anterior perirectal fat to decrease rectal toxicity from radiation delivered with intensity modulated brachytherapy or EBRT for prostate cancer patients. Int J Radiat Oncol Biol Phys 69:95–102PubMedCrossRefGoogle Scholar
Curran MP (2010) Hyaluronic acid (Supartz®): a review of its use in osteoarthritis of the knee. Drugs Aging 27:925–941PubMedCrossRefGoogle Scholar
Kim YS, Rhim H, Paik SS (2006) Radiofrequency ablation of the liver in a rabbit model: creation of artificial ascites to minimize collateral thermal injury to the diaphragm and stomach. J Vasc Interv Radiol 17:541–547PubMedCrossRefGoogle Scholar