Intraductal chilled saline perfusion to prevent bile duct injury during percutaneous radiofrequency ablation for hepatocellular carcinoma.
OBJECTIVE
Radiofrequency ablation (RFA) is a promising, minimally invasive treatment for hepatocellular carcinoma (HCC). However, thermal injury sometimes occurs in the bile duct, potentially leading to a critical situation. The aim of the present study was to investigate whether bile duct injury is reduced by an intraductal chilled saline perfusion (ICSP) through a nasobiliary tube during RFA for HCC.


METHODS
The baseline incidence of bile duct injury at Gifu Municipal Hospital was 3.1% (13 patients) in 424 patients with HCC treated by percutaneous RFA. In all patients, the tumor was within 5 mm of the central bile duct on CT images. The incidence of bile duct injury was 46% among the 28 selected patients whose tumor was close to the central bile duct. To prevent complications in such high-risk patients, we placed a nasobiliary tube endoscopically before RFA, and performed ICSP during RFA. Forty consecutive patients with tumors close to the central bile duct were enrolled in this study.


RESULTS
Of the 40 enrolled patients, only one had biliary injury, whereas the remaining 39 patients were able to avoid it. The incidence of biliary injury was significantly reduced in the ICSP group (1/40, 2.5%) compared to that in the control group (13/28, 46%) (P < 0.0001). Moreover, the liver function 6 months after RFA was also better preserved in the ICSP group according to Child-Pugh grading, thus resulting in a better clinical outcome.


CONCLUSIONS
ICSP through a nasobiliary tube is a potential intervention method to prevent biliary injury by percutaneous RFA.
First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
Takaya
T
Ohnishi
Ichiro
I
Yasuda
Youichi
Y
Nishigaki
Hideki
H
Hayashi
Kentaro
K
Otsuji
Tsuyoshi
T
Mukai
Masamichi
M
Enya
Salem
S
Omar
Nib
N
Soehendra
Eiichi
E
Tomita
Hisataka
H
Moriwaki
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000209:etiology / Q000517:prevention & control*; D001652:Bile Ducts / Q000293:injuries*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012965:Sodium Chloride / Q000008:administration & dosage*
D012965:Sodium Chloride