Abstract
Background
To evaluate the safety and the long-term outcomes of transarterial embolization (TAE)
with lipiodol-bleomycin emulsion (LBE) plus N-Butyl cyanoacrylate (NBCA) in the treatment
of children with large symptomatic focal nodular hyperplasia (FNH).
Methods
This is a retrospective case serial study. Children (aged <18 years) with FNH were
treated. Indications for TAE were patients who were presenting with FNH related abdominal
pain and the maximum diameter of FNH is more than 7 cm, and who were not candidates
for surgical treatment. Technical success, adverse events, symptoms relief rate, and
changes in the lesion size after TAE were evaluated.
Results
Between January 2003 and February 2018, 17 pediatric patients were included. Technical
success was achieved in all patients. Mean follow-up was 67.5 months. All patients
had complete resolution of abdominal symptom. The mean largest diameter of the lesions
decreased from 10.5 cm to 1.9 cm (P < 0.01). The mean volume reduction rate was 96.9%. The complete resolution of the
FNH was observed in 16 patients. No further therapy was needed for all patients.
Conclusions
TAE with LBE plus NBCA appears to be a safe and effective treatment in pediatric patients
with large symptomatic FNH. It could be considered as the first-line treatment for
symptomatic large FNH.
Keywords
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References
- Multidisciplinary management of focal nodular hyperplasia in children: experience with 10 cases.JAMA Surg. 2013; 148: 1068-1070https://doi.org/10.1001/jamasurg.2013.351
- Management of focal nodular hyperplasia of the liver: experience of 50 pediatric patients in a tertiary center.J Pediatr Surg. 2020; 55: 1885-1891https://doi.org/10.1016/j.jpedsurg.2020.01.009
- Benign Liver Tumors.Visc Med. 2020; 36: 292-303https://doi.org/10.1159/000509145
- ACG clinical guideline: the diagnosis and management of focal liver lesions.Am J Gastroenterol. 2014; 109 (quiz 1348): 1328-1347https://doi.org/10.1038/ajg.2014.213
- EASL Clinical Practice Guidelines on the management of benign liver tumours.J Hepatol. 2016; 65: 386-398https://doi.org/10.1016/j.jhep.2016.04.001
- Managing focal nodular hyperplasia of the liver: surgery or minimally-invasive approaches? A review of the preferable treatment options.Anticancer Res. 2018; 38: 33-36https://doi.org/10.21873/anticanres.12188
- Focal nodular hyperplasia: a review of current indications for and outcomes of hepatic resection.HPB. 2014; 16 (Oxford): 503-511https://doi.org/10.1111/hpb.12169
- What is changing in indications and treatment of focal nodular hyperplasia of the liver. is there any place for surgery.Ann Hepatol. 2017; 16: 333-341https://doi.org/10.5604/16652681.1235475
- Growth of hepatocellular adenoma during pregnancy: a prospective study.J Hepatol. 2020; 72: 119-124https://doi.org/10.1016/j.jhep.2019.09.011
- Indications for liver surgery in benign tumours.Eur Surg. 2018; 50: 125-131https://doi.org/10.1007/s10353-018-0536-y
- Should focal nodular hyperplasia still be operated upon? analysis of a case series.Dig Dis. 2019; 37: 309-314https://doi.org/10.1159/000496430
- Surgical indications for focal nodular hyperplasia of the liver: single-center experience of 48 adult cases.Ann Hepatobiliary Pancreat Surg. 2019; 23: 8-12https://doi.org/10.14701/ahbps.2019.23.1.8
- Bland embolization of benign liver tumors: review of the literature and a single center experience.J Clin Med. 2021; 10https://doi.org/10.3390/jcm10040658
- Transarterial embolisation of a large focal nodular hyperplasia, using microspheres, in a paediatric patient.BMJ Case Rep. 2015; 2015https://doi.org/10.1136/bcr-2014-208879
- Transarterial embolization of symptomatic focal nodular hyperplasia.J Vasc Interv Radiol. 2013; 24: 1647-1655https://doi.org/10.1016/j.jvir.2013.07.012
- Transarterial embolization using pingyangmycin lipiodol emulsion and polyvinyl alcohol for the treatment of focal nodular hyperplasia of the liver.Hepatogastroenterology. 2011; 58: 1736-1741https://doi.org/10.5754/hge11174
- Transarterial embolization as a therapeutic option for focal nodular hyperplasia in four patients.Eur Radiol. 2006; 16: 670-675https://doi.org/10.1007/s00330-005-2885-8
- Effectiveness of transarterial embolization in treatment of symptomatic hepatic hemangiomas: systematic review and meta-analysis.Cardiovasc Intervent Radiol. 2021; 44: 80-91https://doi.org/10.1007/s00270-020-02611-5
- Transarterial bleomycin-lipiodol embolization (B/LE) for Symptomatic giant hepatic hemangioma.Cardiovasc Intervent Radiol. 2018; 41: 1674-1682https://doi.org/10.1007/s00270-018-2010-4
- Ten-year experience with arterial embolization for peptic ulcer bleeding: n-butyl cyanoacrylate glue versus other embolic agents.Eur Radiol. 2021; 31: 3015-3026https://doi.org/10.1007/s00330-020-07427-y
- Safety and efficacy of transcatheter embolization with Glubran®2 cyanoacrylate glue for acute arterial bleeding: a single-center experience with 104 patients.Abdom Radiol. 2018; 43 (NY): 723-733https://doi.org/10.1007/s00261-017-1267-4
- Objective response by mRECIST as a predictor and potential surrogate end-point of overall survival in advanced HCC.J Hepatol. 2017; 66: 1166-1172https://doi.org/10.1016/j.jhep.2017.01.012
- Validity and reliability of the pediatric patient-reported outcomes version of the common terminology criteria for adverse events.J Natl Cancer Inst. 2020; 112: 1143-1152https://doi.org/10.1093/jnci/djaa016
- Bleomycin foam treatment of venous malformations: a promising agent for effective treatment with minimal swelling.J Vasc Interv Radiol. 2015; 26: 1484-1493https://doi.org/10.1016/j.jvir.2015.05.007
Article info
Publication history
Published online: January 18, 2023
Accepted:
December 29,
2022
Received:
September 23,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
