Percutaneous Ethanol Injection (PEI)

Patient Selection Criteria

Percutaneous ethanol injection (PEI) is used to treat unresectable Hepatocellular Carcinoma (HCC) that is confined to the liver. It is not an effective treatment for metastatic liver cancer. PEI is used to treat single lesions less than 5 cm (about 2 inches) in diameter or two to three tumors each less than 4 cm in diameter.

Description of Procedure

PEI is performed as an outpatient procedure and requires two or three treatments each week for a total of six to eight treatments for each lesion. Using ultrasound, the tumor is located and absolute ethanol is injected into a tumor. Each lesion is injected with an average of 4-10 ml (1-2 teaspoons) of ethanol. This causes necrosis (death) of the tumor mass.

Risks/Side Effects/Complications

Transient pain at the injection site is common with patients treated with PEI, but the more serious complications of intraperitoneal hemorrhage, hepatic insufficiency, bile duct necrosis, hepatic infarction, and transient hypotension are infrequent.

Recovery Time and Lifestyle Changes

Recovery time is short due to the lack of complications. However, patient compliance is challenging because of the need for six to eight treatments per lesion.

Effectiveness

One Italian study looking at treatment effectiveness was performed with 162 patients, all of which had one solitary tumor less than 5 cm in diameter. Patient survival was 90% at one year and 63% at three years. Treatment seems to be less effective when patients have more than one tumor.

PEI is a safe, effective treatment for patients with Hepatocellular Carcinoma. Complications following treatment are minimal.

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