Percutaneous Ethanol Injection Therapy (Liver): Treatment, Effects & Risks

Percutaneous ethanol injection therapy (liver) is a therapeutic method to treat carcinoma of the liver cells. Percutaneous ethanol injection therapy (liver) is usually abbreviated as PEI therapy. In the procedure, ethanol is delivered by injection, causing localized tissue death.

What is percutaneous ethanol injection therapy (liver)?

Percutaneous ethanol injection therapy (liver) should not be confused with a chemotherapy treatment procedure that is also abbreviated as PEI therapy. This is a therapy in which the substances etoposide, cisplatin and ifosfamide are used against testicular cancer. In percutaneous ethanol injection therapy (liver), ethanol is administered locally at a concentration of 95 percent to patients suffering from liver carcinoma. A special hollow needle is usually used for this purpose. The ethanol is injected directly into the corresponding carcinoma in the liver. In this way, necroses form in the tumors in question, and the tissue dies. The ethanol acts in the cells of the liver and the carcinomas not only directly, but also indirectly through a thrombosis-like effect. This is because the blood vessels supplying the carcinoma first suffer thrombosis and subsequently ischemia. The ethanol has a primarily toxic effect on the cells of the tumor. Numerous research studies on percutaneous ethanol injection therapy (liver) confirm the efficacy of this treatment technique. In particular, the prognosis as well as the survival probability of the treated patients improve. Percutaneous ethanol injection therapy (liver) is applicable only to those individuals who have no more than three foci of carcinoma. These foci must not exceed a diameter of 50 millimeters, and the treatment method promises more success in most cases with less than 30 millimeters. In addition, it is necessary for patients to have good liver function.

Function, effect, and goals

In percutaneous ethanol injection therapy (liver), the liver is specifically punctured using an appropriate hollow needle. The targets of the treatment are carcinomas of the liver cells. The puncture of the organ is performed with the help of sonographic control. In the first step of the therapy, the skin around the area to be punctured is thoroughly disinfected. In addition, the attending physicians sedate the patient, using, for example, the medical agent propofol. The carcinoma in the liver is visualized by ultrasound. The corresponding area is then punctured with a hollow needle. Ethanol with an alcohol content of 95 percent is injected into the carcinoma of the liver cells. The liquid spreads in the tissue of the tumor. On ultrasound monitoring, this gradual distribution of ethanol in the tumor is seen in a cloud-like appearance. Importantly, the outer areas of the carcinoma of liver cells are also monitored and reached by the ethanol. In the majority of cases, percutaneous ethanol injection therapy (liver) is performed in the course of several treatment sessions. A maximum of twelve individual sessions are required. In addition, percutaneous ethanol injection therapy (liver) is often combined with other methods of medical therapy for carcinomas of the liver cells. For example, a combination with transarterial chemoembolization or a so-called radiofrequency ablation is possible. In some diseased patients, percutaneous ethanol injection therapy (liver) is used if tumor foci are still present in the liver during a surgical procedure to remove tumors. This is because in some cases, not all carcinomas of the liver cells can be thoroughly removed. Basically, percutaneous ethanol injection therapy (liver) is one of the palliative procedures for the treatment of hepatocellular carcinoma. This is because, as a rule, the tumors are not completely destroyed. However, the growth of the carcinomas of the liver cells is slowed down.

Risks, side effects, and hazards

First of all, there are numerous contraindications to be considered if the use of percutaneous ethanol injection therapy (liver) is planned. In principle, application of the therapeutic procedure is not possible if the patient concerned suffers from liver cirrhosis in an advanced stage.The so-called Child-Pugh-C stage is particularly relevant and an absolute exclusion criterion for percutaneous ethanol injection therapy (liver). In addition, percutaneous ethanol injection therapy (liver) is not suitable for individuals who have already developed so-called distant metastases. Significant amounts of ascites as well as occlusive icterus also make the use of percutaneous ethanol injection therapy (liver) impossible. The therapeutic procedure is also not indicated in cases of malignant infiltration of the vessels. In addition, various potential side effects of percutaneous ethanol injection therapy (liver) should be noted. One study concluded that about a quarter of all treated patients suffer from fever following the therapy. Some individuals also exhibit severe pain, requiring the use of medications to relieve pain. In addition, liver function decreases in a proportion of patients following percutaneous ethanol injection (liver) therapy. A small group of individuals treated with percutaneous ethanol injection therapy (liver) develop metastases in the puncture site. In addition, some patients develop hemorrhages that extend into the so-called peritoneum. In the worst case, the affected patient dies as a result of percutaneous ethanol injection therapy (liver). Serious bleeding in the abdomen, for example, is a possible cause for death of the treated.