Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

Recent studies have shown that radiofrequency(RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.

Sodium hydroxide-induced esophageal stricture via an endoscopic injection needle: a novel rabbit model of corrosive injury

Purpose: Benign strictures of the esophagus are commonly encountered in clinical practice and are difficult to manage conservatively. This study aimed to establish a novel animal model of benign esophageal stricture by using corrosive-induced injury in rabbits with an injection of sodium hydroxide(NaOH) via a self-made endoscopic injection needle. Materials and Methods: Corrosive injury of the esophagus was induced in 10 rabbits by administration of 1 mL of 1.5% NaOH using a laryngoscope with a self-made endoscopic injection needle. The self-made injection needle was fabricated by modification of the core of an endoscopic injection needle. The laryngoscope examination was performed at 2 weeks and 4 weeks after induction of corrosive injury; esophagography was also performed at 4 weeks to assesse sophageals tricture.A lla nimalsw eree uthanizedat th een dof the fourth week; the esophagus was removed, and stained sectionsw eree xaminedm icroscopically. Results: Laryngoscope examination at 2 weeks showed ulceration. At the end of fo urth we e k,laryngosco py,r a diolo gical, and gross exa m inations showed successful in ductionof e s ophagea l stric turein a llanimal s,without any c omp licatio n.The m eanst r ic t ure inde x at the en dof fourth week wa s49.54±3. 61%; the mean le ngth of stricture w as18.0± 2.5mm.Micros copicexa mina tionrevea ledf ocalulceratio nand subm ucosalth i cke ning secondary to fibrosis. Conclusion:Rab bit esop hageal stri ctu re induced us ing lary ngosc opy with endosco pic injec tion of a sm all am ount of lowcon centration s odium hyd roxid e is a t echn ica lly simp le,safe,and re produ cible meth od for cre atio n of an animal m odel of esophageal stricture.This model can be useful for developing new treatment methods for esop hageal s tricture.

Efficacy and safety of computed tomography-guided microwave ablation with fine needle-assisted puncture positioning technique for hepatocellular carcinoma

BACKGROUND In microwave ablation(MWA), although computed tomography(CT) scanning can overcome gas interference, it cannot achieve real-time localization. Therefore, the puncture technique is more important in CT-guided ablation.AIM To compare the fine needle-assisted puncture(FNP) positioning technique and the conventional puncture(CP) technique for the safety and efficacy of CT-guided MWA in treating hepatocellular carcinoma(HCC).METHODS This retrospective study included 124 patients with 166 tumor nodules from February 2018 and June 2021. Seventy patients received CT-guided MWA under the FNP technique(FNP group), and 54 patients received MWA under the CP technique(CP group). Intergroup comparisons were made regarding local tumor progression(LTP), recurrence-free survival(RFS), overall survival(OS), and complications. The influencing variables of LTP and RFS were analyzed through univariate and multivariate regressions.RESULTS The 1-, 2-, and 3-year cumulative incidences of LTP in the FNP group were significantly lower than those in the CP group(7.4%, 12.7%, 21.3% vs 13.7%, 32.9%, 36.4%;P = 0.038). The 1-, 2-, and 3-year RFS rates in the FNP group were significantly higher than those in the CP group(80.6%, 73.3%, 64.0% vs 83.3%,39.4%, and 32.5%, respectively;P = 0.008). The FNP technique independently predicted LTP and RFS. Minor complications in the FNP group were lower than those in the CP group(P < 0.001). The difference in median OS was insignificant between the FNP and CP groups(P = 0.229).CONCLUSION The FNP technique used in CT-guided MWA may improve outcomes in terms of LTP, RFS, and procedure-related complications for HCC.

Silicone-covered biodegradable magnesium stent for treating benign esophageal stricture in a rabbit model

BACKGROUND Stent insertion can effective alleviate the symptoms of benign esophageal strictures(BES).Magnesium alloy stents are a good candidate because of biological safety,but show a poor corrosion resistance and a quick loss of mechanical support in vivo.AIM To test the therapeutic and adverse effects of a silicone-covered magnesium alloy biodegradable esophageal stent.METHODS Fifteen rabbits underwent silicone-covered biodegradable magnesium stent insertion into the benign esophageal stricture under fluoroscopic guidance(stent group).The wall reconstruction and tissue reaction of stenotic esophagus in the stent group were compared with those of six esophageal stricture models(control group).Esophagography was performed at 1,2,and 3 weeks.Four,six,and five rabbits in the stent group and two rabbits in the control groups were euthanized,respectively,at each time point for histological examination.RESULTS All stent insertions were well tolerated.The esophageal diameters at immediately,1,2 and 3 wk were 9.8±0.3 mm,9.7±0.7 mm,9.4±0.8 mm,and 9.2±0.5 mm,respectively(vs 4.9±0.3 mm before stent insertion;P<0.05).Magnesium stents migrated in eight rabbits[one at 1 wk(1/15),three at 2 wk(3/11),and four at 3 wk(4/5)].Esophageal wall remodeling(thinner epithelial and smooth muscle layers)was found significantly thinner in the stent group than in the control group(P<0.05).Esophageal injury and collagen deposition following stent insertion were similar and did not differ compared to rabbits with esophageal stricture and normal rabbits(P>0.05).CONCLUSION Esophageal silicone-covered biodegradable magnesium stent insertion is feasible for BES without causing severe injury or tissue reaction.Our study suggests that insertion of silicone-covered magnesium esophageal stent is a promising approach for treating BES.

Transarterial chemoembolization with PD-(L)1 inhibitors plus molecular targeted therapies for hepatocellular carcinoma(CHANCE001)

There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations.In this nationwide,retrospective,cohort study,826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT(combination group,n=376)or TACE monotherapy(monotherapy group,n=450)were included from January 2018 to May 2021.The primary endpoint was progression-free survival(PFS)according to modified RECIST.The secondary outcomes included overall survival(OS),objective response rate(ORR),and safety.We performed propensity score matching approaches to reduce bias between two groups.After matching,228 pairs were included with a predominantly advanced disease population.Median PFS in combination group was 9.5 months(95%confidence interval[CI],8.4-11.0)versus 8.0 months(95%CI,6.6-9.5)(adjusted hazard ratio[HR],0.70,P=0.002).OS and ORR were also significantly higher in combination group(median OS,19.2[16.1-27.3]vs.15.7 months[13.0-20.2];adjusted HR,0.63,P=0.001;ORR,60.1%vs.32.0%;P<0.001).Grade 3/4 adverse events were observed at a rate of 15.8%and 7.5%in combination and monotherapy groups,respectively.Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS,OS,and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice,with an acceptable safety profile.