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Percutaneous ethanol injection therapy: a surgery-sparing treatment for primary hyperparathyroidism
Spyros Stratigis1, Kostas Stylianou, Evangelia Mamalaki
1Departments of Nephrology, University Hospital of Heraklion, Crete, Greece.
Clinical Endocrinology
|March 12, 2008
Summary
Percutaneous ethanol injection therapy (PEIT) offers a safe and effective alternative to surgery for primary hyperparathyroidism (p-HPT). This minimally invasive treatment normalized intact parathormone levels in 58% of high-risk patients, with 89.5% achieving normocalcemia.
Area of Science:
- Endocrinology
- Minimally Invasive Surgery
- Interventional Radiology
Background:
- Primary hyperparathyroidism (p-HPT) often requires surgical management.
- High-risk patients may not be suitable candidates for parathyroidectomy.
- Percutaneous ethanol injection therapy (PEIT) presents a potential alternative treatment modality.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of PEIT for p-HPT.
- To assess PEIT as a nonsurgical option for patients ineligible for surgery.
- To describe a 3-year experience with PEIT in managing p-HPT.
Main Methods:
- A prospective study involving 19 high-risk patients with p-HPT.
- Ultrasonically guided percutaneous ethanol injection into parathyroid glands (>or= 0.15 cm³).
- Repeated injections every 2 weeks until iPTH normalization or gland devascularization; biochemical monitoring.
Main Results:
- Normalization of intact parathormone (iPTH) achieved in 11 patients (58%) at 6 months.
- 89.5% of patients (17/19) became and remained normocalcemic for a mean of 21 months.
- Pretreatment iPTH < 200 ng/l significantly predicted response (Odds Ratio 16.7).
- Transient dysphonia was the only complication in three patients.
Conclusions:
- PEIT is a safe and effective nonsurgical treatment for p-HPT.
- It is a viable option for patients unsuitable for surgical intervention.
- PEIT demonstrates long-term efficacy in managing p-HPT biochemistries.
