P.03.10 VITAMIN B12 SUPPLEMENTATION IMPROVES SUSTAINED-VIRAL-RESPONSE RATES IN HEPATITIS C VIRUS GENOTYPE 1B-INFECTED PATIENTS

Background and aim: We previously described a case of EUS-guided Nd:YAG (neodymium:yttrium-aluminium-garnet) LA of a HCC lesion located into the caudate lobe, not suitable for percutaneous approach. Aim is to confirm the feasibility of EUS-guided Nd:YAG LA of HCC in unsafe conditions for the percutaneous approach. Material and methods: Treatment was performed in 2 patients with multifocal HCC unsuitable for surgical resection or liver transplant. First one was affected by criptogenetic liver cirrhosis Child-Pugh A6 and lesion was site in the caudate lobe with huge ombelical vein and portal hypertension. The location of the lesion and the difficult ultrasonography visualization precluded percutaneous treatment. Second patient was affected by HCV and HIV cirrhosis Child-Pugh B9 with ascites and portal hypertension. Both patients underwent previous failed transarterial embolization (TACE) and RFA of lesions located into segment 1 and 3 respectively. Trans-gastric EUS-puncture was performed using a 22-gauge needle following the application of Doppler. A Nd:YAG laser with a wavelength of 1.064 nm was used. As previously described the treatment was planned taking into account the baseline volume of the lesions at EUS and the volume of necrosis that could be achieved in relation to the energy delivered. Results: Lesions were easier targeting through the lesser gastric curve. Application of Nd:YAG LA did not have any negative effect on the quality of the EUS images during the treatment and the whole treated area was occupied by an irregular and poorly defined echogenic zone at the end. The patients didn’t report any pain or abdominal discomfort after treatment and were discharged on the third postoperative day without complications. CT performed 24 hours after procedure showed the whole treated area replaced by an homogeneous, hypoattenuating, nonenhancing area. At 2 months follow-up clinical examination and blood analysis tests were normal. CT-scan showed uniform hypoattenuation without enhancement in the ablated zone and confirm the success to ablate the entire lesion. Conclusions: EUS-guided Nd:YAG LA of a HCC is feasible and safe in lesions in which the percutaneous approach is unsure. This promising results need to be confirmed in additional patients with lesions difficult to reach by conventional ablative methods or in patients whit compromised clinical conditions.