📖 What is percutaneous alcoholization?
Percutaneous alcoholization (or absolute ethanol injection) is an interventional radiology technique that injects 95% pure alcohol into a lesion or around a nerve, under imaging guidance (ultrasound or CT). The alcohol causes cell destruction by dehydration, dénaturation protéique et thrombose vasculaire.
The main indications are: symptomatic renal cysts (sclerosis), liver metastases from insulinomas or endocrine tumours, nerve ganglia (coeliac alcohol block for cancer pain), and benign thyroid tumours (cysts, hot nodules). Outpatient technique, local anaesthesia.
ℹ️ Morton neuroma is not treated by alcoholization in our centre: it is managed by percutaneous cryoablation, a different and dedicated technique.
What are the expected benefits?
Percutaneous alcoholization can be offered to treat symptomatic cysts or certain benign nodules, as an alternative to surgery. The expected benefits are:
- Lasting reduction in volume of the cyst or of the fluid component of the treated nodule
- Reduction or disappearance of symptoms related to compression (pain, discomfort)
- Outpatient technique under local anaesthesia, with no incision or scar
- Alternative for inoperable patients (e.g. parathyroid adenoma)
- Repeatable in case of recurrence
Main indications
- Thyroid cyst: alcoholization of a symptomatic or large benign thyroid cyst
- Liver cyst: sclerotherapy of a symptomatic liver cyst
- Renal cyst: treatment of a symptomatic renal cyst (pain, compression)
- Partially cystic thyroid nodule: alcoholization to reduce the fluid component
- Overactive parathyroid: alcoholization of a parathyroid adenoma in inoperable patients
Principles and course of the procedure
Alcoholization (or percutaneous sclerotherapy) involves injecting, under ultrasound or CT guidance, a chemical agent (95% pure ethyl alcohol, or another sclerosing agent) directly into a lesion to destroy it without surgery. The alcohol causes cell destruction by dehydration, protein denaturation and vascular thromboculaire.
How does it work?
Performed on an outpatient basis: under local anaesthesia
Puncture of the lesion under real-time ultrasound guidance
Aspiration of the fluid content (cyst) if needed
Injection of the sclerosing agent into the lesion. Total duration: 20 to 45 minutes
Short monitoring, then discharge home the same day
What is the aftercare?
Effets attendus et transitoires :
- Moderate transient pain at the treatment site, managed with simple painkillers
- Progressive shrinkage of the lesion over several weeks
Les complications sont les suivantes :
| Complication | Description | Frequency |
|---|---|---|
| Local pain during injection | Brief, related to alcohol diffusion | Common |
| Partial recurrence of the lesion | A repeat alcoholization remains possible | 5–15 % |
| Diffusion of alcohol to adjacent tissues | Prevented by precise guidance; exceptional | Exceptional |
| Infection | Treated with antibiotics if needed | < 1 % |
Follow-up after treatment
- Ultrasound follow-up at 3 and 6 months
- In case of recurrence, a repeat alcoholization remains possible
What are the limits of the treatment?
- Alcoholization treats the lesion targeted at the time of the procedure, but does not prevent new lesions from forming
- A partial recurrence is possible (5 to 15%) — a further session then remains possible
- For large or complex lesions, efficacy may be incomplete and require a complementary approach
Dans tous les cas, la chirurgie ou d'autres techniques restent possibles.
What other techniques and alternatives are available ?
🏥 Surgery
Surgical removal of the lesion, more invasive, reserved for failures or lesions not accessible percutaneously.
❄️ Thermal ablation
Radiofrequency or microwave for solid nodules, depending on the nature of the lesion.
👁️ Watchful waiting
For small, asymptomatic lesions, simple ultrasound monitoring may be sufficient.
💊 Medical treatment
Depending on the lesion (for example medical treatment of parathyroid adenomas), discussed together with the referring specialist.
What happens if I ultimately decline the treatment?
You remain entirely free in your decision. Your doctor will discuss the alternatives with you: surgery, thermal ablation, medical treatment or monitoring depending on the nature of the lesion.
✅ Procedure covered by French national health insurance. No extra fees (standard AP-HP public tariff).
❓ Frequently asked questions
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