Ethanol Ablation

Overview

Ethanol ablation of a thyroid nodule, also known as percutaneous ethanol injection (PEI), is a minimally invasive procedure used to treat benign thyroid nodules. By injecting ethanol directly into the nodule, this technique aims to reduce its size and alleviate symptoms without the need for surgery. Ethanol ablation is particularly useful for cystic nodules that contain fluid, and is rarely used for solid nodules at this time. It can also be used for recurrent cancers, but this is somewhat controversial, as it induces scar tissue that can make future surgery more challenging.

Procedure

‍During the procedure, a needle is inserted into the thyroid nodule under ultrasound guidance, and the fluid in the nodule is removed. Often, the cyst is irrigated with saline to remove any residual debris. Finally, ethanol, a type of alcohol, is injected into the nodule. The ethanol causes scar tissue along the capsule wall of the cyst, which hopefully prevents future fluid from re-accumulating. That fluid can either be removed or left in place after the injection. The procedure is usually performed on an outpatient basis, allowing patients to return home shortly after.

Benefits and Risks

‍Ethanol ablation offers the advantage of being a minimally invasive alternative to surgery, with a quick recovery time and minimal risk of complications. It is usually most effective for cystic nodules, and can become less effective as nodules increase in size. It also becomes a less ideal option if a cyst has loculations (small walls or partitions that separate the fluid) because it is common that not all pockets will respond. Potential risks include pain at the injection site, leakage of ethanol into surrounding tissues, and infection. Your doctor will discuss these risks with you before the procedure.

Additionally, as with most treatments of thyroid nodules, voice changes could happen and be permanent or temporary.

Recovery and Follow-Up

‍Recovery from ethanol ablation is generally quick, with most patients resuming normal activities within a day or two. Mild discomfort at the injection site is common and can be managed with over-the-counter pain medications. Follow-up visits are important to monitor the treated nodule and ensure that the procedure was successful. Multiple sessions may be required to achieve the desired results.

When the result is not achieved after the first round, alternatives such as RFA can also be considered.