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ENDOSCOPIC ULTRASOUND (EUS)-GUIDED TREATMENT OF A SOLID HEPATIC MALIGNANCY
RL Barclay1, M Giovannini2, Manuel Perez-Miranda3
1GI Diseases Research Unit, Queen’s University, Kingston, Ontario, 2Institut Paoli-Calmettes, Marseille, France and 3Antonio Lorenzo Hospital, Valladolid, Spain
BACKGROUND: Current therapy for hepatic malignancy is suboptimal. EUS is superior to transcutaneous modalities for imaging the upper gastrointestinal tract and adjacent solid organs (especially the left liver). We report the first successful case of EUS-guided treatment for a left hepatic tumor.
METHODS: A 65-year old man developed a segment IV left hepatic metastasis from pancreatic adenocarcinoma. The hepatic tumor initially responded to systemic chemotherapy but eventually became refractory to this treatment. The location of the lesion precluded therapy with percutaneous ablative techniques. Over a 5½-year period, adjuvant EUS-guided therapy was administered with transgastric injections of absolute ethanol into the tumor via a PentaxÒ FG-36UX linear array echoendoscope.
RESULTS: EUS defined the location of the primary malignancy (pancreas) and facilitated local ablational therapy for the hepatic metastasis. Seven EUS-guided injections of ethanol (mean volume, 6 ± 1 cc) were performed. Following most treatment sessions the lesion size and accompanying serum tumor marker level either stabilized or decreased. There were no major complications.
CONCLUSION: This report demonstrates the technical feasibility of EUS-guided therapy for hepatic tumors, which may thus expand the therapeutic repertoire of EUS. Studies are needed to define the role of EUS in the current therapeutic approach to hepatic malignancy.