Long-Term Follow-Up of Giant Symptomatic Hepatic Hemangiomas Treated with Direct Sclerotherapy: Introducing a New Approach

Objectives: To investigate the feasibility, safety, and efficacy of percutaneous sclerotherapy using intralesional bleomycin injection in reducing the symptoms and volume of the Giant Liver Hemangiomas. Methods: This prospective study was conducted from April 2016 to June 2019. Patients with persistent abdominal pain or discomfort directly caused by hemangioma (confirmed by computed tomographic scan) who refused surgical option were included. Patients with any coagulopathy states (platelet count <100,000 or international normalized ratio >1.5) were excluded. All demographic variables and laboratory tests as well as patients' symptoms and complaints during this period were recorded. All procedures were performed in an outpatient setting under local anesthesia. Patients underwent percutaneous intralesional sclerotherapy using bleomycin-lipiodol mixture under fluoroscopic guidance. All early and late complications, if any, were recorded. GLH volume and three-dimensional diameters as well as pain severity (according to visual analog scale [VAS]) were documented before and 36 months after the procedure. Results: Five patients (4 [80%] females, mean age: 43.8 years, range 33–51) were recruited for the current survey. Mean GLH volume was 378.60 ± 229.80 cc before the sclerotherapy, which was dropped to 143.20 ± 165.54 cc (71.3% ± 19.9%) on the 36-month follow-up (P < 0.001). Mean GLH's longest diameter before the procedure was 108.60 ± 18.76 mm, which was declined to 64.60 ± 33.71 mm (42.6% ± 20.5%) (P = 0.035). Patients' VAS score before the procedure was 8.60 ± 0.89, which was decreased to 4.40 ± 1.14 on the follow-up (P = 0.002). Liver function tests revealed no abnormalities before the procedure, 1 day after the treatment, and on the 36-month follow-up. No allergic reaction was observed. One of our patients had self-limiting intraperitoneal hemorrhage which led to a 3-day hospital stay and then was discharged with stable condition. No other early or late complication was detected. Conclusion: Percutaneous sclerotherapy is a relatively safe and effective method in GLH treatment. Further investigations in larger samples and in comparison with control group (in clinical trial setting) are required to confirm the current findings.