EUS dating with laser ablation against the caudate lobe or left liver tumors: a win-win proposition?

Abstract

Endoscopic ultrasound (EUS) have been not only a diagnostic tool, but also available in interventional therapy, which often previously needed surgical approaches to achieve. The study aimed to evaluate the effectiveness and safety of EUS-guided Nd:YAG laser ablation in unresectable tumors of the caudate lobe and left liver. We discussed ten cases of the caudate lobe and left liver tumors underwent laser ablation with EUS guidance. And we also have reviewed previous publication of EUS-guided thermal ablation for liver tumors in several decade years. EUS-guided Nd:YAG laser ablation (LA) of these tumors were successfully completed in ten patients, who had favourable prognosis with no complications in two-month follow-up. Based on our early observations, this suggested that EUS-guided LA might be technically feasible in selected patients with tumors of the caudate lobe and left liver. However, the safety of this technique need to be further confirmed in the future and if possible larger, prospective trials.

Keywords: Ablation; endoscopic ultrasonography; intervention EUS; laser ablation; liver; tumor; ultrasonography.

Figures

Figure 1.

A 63-year-old man with hepatocellular carcinoma. Preoperative MR and CEUS images showed a mass of 2.2*1.7 cm in size in the caudate lobe (a, b and c) (white arrows). EUS suggested laser fiber inserted into the tumor (d) and then total enhancement of the lesion (e) (white arrows). One year later, substance phase MR image showed that the mass has a complete response (f) (white arrows).

Figure 2.

Representative images from a 70-year-old man diagnosed liver metastasis from colon cancer. T1 and T2 MR images revealed a tumor about 2.1*1.7 cm in the caudate lobe (a and b) (white arrows). One laser fiber was ablating the tumor with local enhancement (c) (white arrows). T2 MR image two months obtained after ablation showed complete response in the tumor (d) (white arrows). At the corresponding ultrasounography, it also showed a complete necrosis without any enhanced perfusion in CEUS (e and f) (white arrows).

Figure 3.

A 57-year-old man with hepatocellular carcinoma. MR obtained one month before ablation showed the tumor measuring 1.3*1.2 cm in diameter in the caudate lobe (a) (arrowheads). Preoperative EUS indicated a low echo area (b) (arrowheads) and it had increased echogenicity covering the whole mass after ablation (c) (arrowheads). After one month, enhanced MR revealed the lesion complete necrosis (d) (arrowheads).

Figure 4.

Representative images from a 54-year-old man diagnosed with hepatocellular carcinoma. Preoperative T2 MR image shows a round tumor about 1.1*1.0 cm in the left liver (a) (arrowheads). After enhanced perfusion of this tumor under CEUS guidance (b) (arrowheads), then a laser fiber ablated the target tumor (c) (arrowheads), and immediately CEUS showed no enhanced perfusion (d) (arrowheads). During six-month follow-up after ablation, T1 (e) and substance phase MR images (f) showed the mass was successfully ablated (arrowheads).