Efficacy of minocycline hydrochloride aspiration sclerotherapy with additional monoethanolamine oleate aspiration sclerotherapy for symptomatic hepatic cysts.

Abstract

Minocycline hydrochloride (MINO) aspiration sclerotherapy (AS) has been widely used for treating hepatic cysts (HC). However, cyst recurrence remains problematic. Information on monoethanolamine oleate (EO) AS, another effective HC treatment, is currently limited. We investigated the efficacy of EO on ineffective MINO treatments, and the relationship between MINO AS and cyst fluid pH. A total of 22 cases with symptomatic HC underwent AS with 500mg of MINO from January 2016 to June 2021. Cyst fluid pH was measured before and after MINO injection. Cyst volume ratio (CVR, %) after 2weeks was calculated as follows:cyst volume 2weeks after MINO injection/pre-treatment cyst volume×100. Treatment was completed if CVR after 2weeks was ≤35% (MINO-group). For patients with CVR >35%, 2g of EO was added (MINO/EO-group). Cyst volume ratio was measured every 12months thereafter. There were no recurrence symptoms in any of the patients during follow-up. Of the 22 cases, 21 had CVR ≤20% after 12months. The MINO/EO-group (n=8) tended to have smaller CVRs after 12months than the MINO-group (n=14). Cyst volume ratio after 2weeks was correlated to pH change (p=0.012) and was larger in patients whose pH decreased by <1.5 (p=0.015). All adverse events were mild, including in elderly patients. Adding EO is an effective and safe treatment for symptomatic HC when MINO AS alone is insufficient. Patients with pH decreases of <1.5 should be considered for additional EO treatment.