Large Symptomatic Hepatic Cysts Research Articles

A case of long-term efficacy of minocycline hydrochloride sclerotherapy combined with intra-cystic lavage for a symptomatic giant liver cyst

Herein, we report a case of a man with a large symptomatic hepatic cyst that gradually enlarged over a follow-up period of 15 years, which eventually caused epigastric fullness and obstructive jaundice. The patient underwent percutaneous cystic drainage followed by sclerotherapy using minocycline hydrochloride combined with intracystic lavage. The treatment resulted in a significant reduction in the hepatic cyst size, symptom improvement, and absence of recurrence for 670 days.

S3305 Endoscopic Management of Pancreatic Ascites Following Surgical Fenestration of a Large Symptomatic Hepatic Cyst

S3305 Endoscopic Management of Pancreatic Ascites Following Surgical Fenestration of a Large Symptomatic Hepatic Cyst

Long-term safety and efficacy of ethanol retention therapy via percutaneous approach and/or EUS guidance for symptomatic large hepatic cysts (with video).

Background and Objectives:Ethanol retention therapy (ERT) under EUS guidance or a percutaneous approach is a safe treatment for large symptomatic hepatic cysts. However, reports on the long-term outcomes after ERT are very rare. Therefore, we aimed to evaluate the long-term outcomes of ERT in symptomatic large hepatic cysts.Materials and Methods:A total of 47 consecutive patients with large symptomatic hepatic cysts treated at the Asan Medical Center from April 2009 to October 2017 were analyzed. Thirty patients with right hepatic cysts were treated with ERT through a percutaneous approach, and 14 patients with left hepatic cysts were treated with ERT under EUS guidance. Three patients were treated with ERT using both methods.Results:Of the 47 patients, 43 (91%) showed complete regression and four (9%) showed partial regression on abdominal computed tomography. Recurrence of the cysts was not observed during the follow-up surveillance of a median of 66 months.Conclusions:Percutaneous catheter drainage-guided ERT and EUS-guided ERT, based on their favorable long-term outcomes, may be considered as first-line treatments in patients with large symptomatic hepatic cysts.

Ethanol sclerotherapy or polidocanol sclerotherapy for symptomatic hepatic cysts.

BackgroundOver the past decades, multiple approaches to aspiration sclerotherapy of large symptomatic hepatic cysts have been investigated. However, comparative data are scarce.ObjectiveThe objective of this article is to compare cyst reduction, symptomatic relief, and adverse events between ethanol sclerotherapy and polidocanol sclerotherapy.MethodsThis retrospective study included adults having a symptomatic hepatic cyst treated at a European tertiary referral center with ethanol sclerotherapy (Center 1) or polidocanol-sclerotherapy (Center 2). We compared cyst diameter reduction (%) and symptom improvement (yes/no) within 12 months’ post-treatment between centers using multivariate regression analyses adjusted for confounding factors. Finally, we compared adverse events using Fisher’s exact test.ResultsWe included 71 patients from Center 1 and 66 patients from Center 2 (median age 57 years; 126/137 (92%) female). Cyst reduction was comparable between Centers 1 and 2: 37.5% (IQR 15.7–61.0%) versus 44.2% (IQR 24.6–60.5%), respectively (p = 0.35). Correspondingly, symptomatic relief was comparable: 30/53 (56.6%) versus 43/66 (65.2%), respectively (p = 0.88). Center 1 reported significantly more (11 versus 3; p = 0.047) adverse events than Center 2.ConclusionWe found comparable cyst reduction and symptomatic relief rates between ethanol- and polidocanol sclerotherapy, while adverse events occurred more often in the ethanol group. Prospective studies focused on clinical response are needed to further explore differences between approaches.

Pasireotide does not improve efficacy of aspiration sclerotherapy in patients with large hepatic cysts, a randomized controlled trial

ObjectivesWe tested whether complementary use of the somatostatin analogue pasireotide would augment efficacy of aspiration sclerotherapy of hepatic cysts.MethodsWe conducted a double-blind, placebo-controlled trial in patients who underwent aspiration sclerotherapy of a large (>5 cm) symptomatic hepatic cyst. Patients were randomized to either intramuscular injections of pasireotide 60 mg long-acting release (n = 17) or placebo (sodium chloride 0.9 %, n = 17). Injections were administered 2 weeks before and 2 weeks after aspiration sclerotherapy. The primary endpoint was proportional cyst diameter reduction (%) from baseline to 6 weeks. Secondary outcomes included long-term cyst reduction at 26 weeks, patient-reported outcomes including the polycystic liver disease-questionnaire (PLD-Q) and safety.ResultsThirty-four patients (32 females; 53.6 ± 7.8 years) were randomized between pasireotide or placebo. Pasireotide did not improve efficacy of aspiration sclerotherapy at 6 weeks compared to controls (23.6 % [IQR 12.6–30.0] vs. 21.8 % [9.6–31.8]; p = 0.96). Long-term cyst diameter reduction was similar in both groups (49.1 % [27.0–73.6] and 45.6 % [29.6–59.6]; p = 0.90). Mean PLD-Q scores improved significantly in both groups (p < 0.01) without differences between arms (p = 0.92).ConclusionsIn patients with large symptomatic hepatic cysts, complementary pasireotide to aspiration sclerotherapy did not improve cyst reduction or clinical response.Key Points• Complementary pasireotide treatment does not improve efficacy of aspiration sclerotherapy.• Cyst fluid reaccumulation after aspiration sclerotherapy is a transient phenomenon.• Aspiration sclerotherapy strongly reduces symptoms and normalizes quality of life.

Treatment of the large hepatic cysts by the ethanol retention therapy with endoscopic ultrasonography guidance and a percutaneous approach

Background and Objectives:Most hepatic cysts are asymptomatic with no need for treatment. However, large symptomatic hepatic cysts need treatment. Ultrasound-guided or computed tomography-guided percutaneous aspiration alone is less invasive, but this approach is associated with high recurrence. A surgical approach for these cysts provides satisfactory long-term outcomes, but it is associated with high perioperative morbidity and complication. The aim of the present study was to evaluate the utility of endoscopic ultrasonography (EUS) guidance and percutaneous ethanol retention for the treatment of symptomatic large benign liver cysts.Methods:Patients were treated by ethanol retention therapy from April 2009 to December 2016 in Asan Medical Center. Ethanol retention therapy through percutaneous and/or EUS-guided approaches was performed. Primary outcomes are feasibility, efficacy, and safety of ethanol lavage.Results:Forty-one patients with 51 hepatic cysts were enrolled. Thirty-one cysts were drained by the percutaneous approach with a pigtail catheter, and 22 cysts were aspirated with EUS guidance. In three cases, both the percutaneous approach and EUS-guided puncture were used. During the median 13-month follow-up of the percutaneous approach group, the cysts showed 100% reduction. During the median 15-month follow-up of the EUS-guided group, the cysts showed nearly 100% reduction. This is a single-center retrospective study.Conclusion:Percutaneous catheter-guided and EUS-guided ethanol retention therapy showed good radiologic responses, low adverse events, and great efficacy in large hepatic cyst. Both of these methods could be used as primary treatment of large hepatic cysts.

Long-term follow-up of large symptomatic hepatic cysts treated by percutaneous ethanol sclerotherapy.

As a minimally invasive treatment, ethanol sclerotherapy has been used for large symptomatic hepatic cysts, but there are not many long-term reports on treatment outcomes and safety. To evaluate the long-term outcomes of percutaneous ethanol sclerotherapy in patients with large symptomatic hepatic cysts. This study included 43 symptomatic, enlarging hepatic cysts in 42 patients who had undergone ethanol sclerotherapy from 2003 to 2013 and were followed up for >1 year. The treatment outcomes were evaluated in terms of the reduction of cyst size and resolution of symptoms. The patients were followed up for a mean period of 33 months with either ultrasound or computed tomography examination. Thirty-nine hepatic cysts (91%) were successfully treated with ethanol sclerotherapy, showing resolution of symptoms and remarkable reduction in cyst volume. Eight hepatic cysts (19%) disappeared completely, and 31 hepatic cysts (72%) decreased in size during the follow-up period. The mean diameter of the cysts decreased from 12.5 ± 4.4 cm to 3.8 ± 3.4 cm during follow-up. There were no immediate serious complications related to the procedure. There were four cases (9%) of treatment failure requiring subsequent surgical procedures. Percutaneous ethanol sclerotherapy can be considered as an effective first-line treatment for large symptomatic hepatic cysts.

P1326 : Pasireotide in addition to aspiration sclerotherapy to improve treatment of large symptomatic hepatic cysts: A randomized, double-blind, placebo-controlled trial

P1326 : Pasireotide in addition to aspiration sclerotherapy to improve treatment of large symptomatic hepatic cysts: A randomized, double-blind, placebo-controlled trial

Aspiration sclerotherapy combined with pasireotide to improve reduction of large symptomatic hepatic cysts (SCLEROCYST): study protocol for a randomized controlled trial.

BackgroundAspiration sclerotherapy is an effective therapeutic option for large symptomatic hepatic cysts. However, incomplete cyst reduction following aspiration sclerotherapy is frequently reported. Strong post-procedural cyst fluid secretion by cholangiocytes, which line the epithelium of the hepatic cyst, seems to be associated with lower reduction rates. Previous studies showed that somatostatin analogues curtail hepatic cyst fluid production. This trial will evaluate the effect of aspiration sclerotherapy combined with the somatostatin analogue pasireotide on cyst reduction. By combining treatment modalities we aim to improve cyst reduction leading to greater symptomatic relief and reduced rates of cyst recurrence.Methods/DesignThis single center, randomized, double-blind, placebo-controlled clinical trial evaluates the additional effect of pasireotide when combined with aspiration sclerotherapy in patients with a large (>5 cm) symptomatic hepatic cyst. A total of 34 participants will be randomized in a 1:1 ratio. In the active arm, patients will receive pasireotide (long-acting release, 60 mg injection) two weeks prior to and two weeks following aspiration sclerotherapy. Patients in the control arm will receive placebo injections at corresponding intervals. The primary outcome is proportional cyst diameter reduction four weeks after aspiration sclerotherapy compared to baseline measurements, obtained by ultrasonography. As secondary outcomes, proportional volume reduction, recurrence, symptomatic relief and improvement of health-related quality of life will be assessed. Furthermore, safety and tolerability of the combination of pasireotide and aspiration sclerotherapy will be evaluated.DiscussionThis trial aims to improve efficacy of aspiration sclerotherapy by a combined approach of two treatment modalities. We hypothesize that pasireotide will decrease fluid re-accumulation after aspiration sclerotherapy, leading to effective hepatic cyst reduction and symptomatic relief.Trials registrationThis trial is registered with ClinicalTrials.gov (identifier: NCT02048319; registered on 6 January 2014) and EudraCT (identifier: 2013-003168-29; registered on 16 August 2013).

Symptomatic hepatic cysts: treatment with single-shot injection of minocycline hydrochloride.

To assess the efficacy of percutaneous minocycline hydrochloride sclerotherapy in symptomatic hepatic cysts. From November 1992 to June 1994, seven of eight consecutive adults with large symptomatic hepatic cysts (diameter, 55-130 mm) were treated with a single intracystic injection of minocycline hydrochloride in an ambulatory procedure. Five patients had a solitary cyst, and two had polycystic liver disease. The target cyst was punctured under ultrasound guidance and local anesthesia with a 22-gauge Chiba needle. Half of the cyst content was aspirated before injection of 100-500 mg of minocycline hydrochloride diluted in 5-25 mL of saline. The minocycline hydrochloride was left in the cyst at the end of the procedure. After a mean follow-up of 28 months (range, 24-42 months), all five patients with solitary cysts were asymptomatic and four had documented complete cyst regression; the two patients with multiple hepatic cysts showed only transient clinical improvement. Single-shot injection of minocycline hydrochloride is an effective treatment for symptomatic solitary hepatic cysts but is less effective in polycystic liver disease.