Feasibility, Safety, and Effectiveness of Bleomycin Electrosclerotherapy in Patients with “Giant Hepatic Hemangiomas”

This retrospective study evaluated the feasibility, safety, and effectiveness of bleomycin electrosclerotherapy (BEST) in nine patients with symptomatic, size-progressive "giant hepatic hemangiomas" unsuitable for surgery. BEST was performed under general anesthesia using six CT-guided needle electrodes. Bleomycin was administered intravenously in three patients and intralesionally in six (3,000-16,430 IU). Follow-up MRI was recommended three months after treatment. Median volume reduction at first follow-up was 18.3% (IQR, 2.7%-36.2%; P = .020) at a median of 77 days (IQR, 44-117 days). Extended follow-up in eight patients demonstrated a median volume reduction of 47.0% (IQR, 17.5%-73.2%; P = .016) at 299 days (IQR, 256-739 days). Six of nine patients reported symptom improvement during follow-up. No major complications occurred; adverse events included three asymptomatic perihepatic hematomas and one intercostal neuralgia requiring prolonged analgesic treatment. BEST was feasible and associated with lesion volume reduction and symptom improvement in this cohort. LEVEL OF EVIDENCE: Level 4, Case Series.