Percutaneous Ethanol Injection

The chapter considers the principles, the techniques, the results of PEI for treating cirrhotic patients with HCC, and its current indications compared to those of RF, which is now considered the gold standard.HCC is an organ pathology, so the first nodule detected is only a prelude to others. Therefore, hepatic resection or percutaneous ablation therapies can offer a palliative cure, achieving only a local control of the disease. Although it is understood that surgery assures the highest possibility to completely ablate the tumor and the possible satellites, recent RCTs comparing resection and percutaneous ablation therapies demonstrated roughly equivalent results.As radiofrequency is actually considered the gold standard ablation technique, the current place of PEI has to be determined. Of course where radiofrequency is not available PEI remains a valid treatment for HCC, especially for health-care systems with limited economical resources. Moreover in all those cases in which radiofrequency is considered to be at risk for complications, PEI is a valid alternative, i.e., in case of lesions adjacent to main biliary ducts or to intestinal loops. PEI is also useful to treat lesions close to large vessels, as it is not affected by the so-called sink effect. PEI remains a good indication to treat segmental portal thrombosis.