Management of Simple Hepatic Cyst

Shimizu, Tetsuya; Yoshioka, Masato; Kaneya, Yohei; Kanda, Tomohiro; Aoki, Yuto; Kondo, Ryota; Takata, Hideyuki; Ueda, Junji; Kawano, Youichi; Hirakata, Akito; Matsushita, Akira; Taniai, Nobuhiko; Mamada, Yasuhiro; Yoshida, Hiroshi

doi:10.1272/jnms.jnms.2022_89-115

Cited by 23 publications

(25 citation statements)

References 57 publications

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“…Because of the increased cyst size and increased mesenteric adipose tissue density around the cyst on CT and the septal structures within the cyst on US, we suspected cyst infection and performed cyst puncture, which revealed findings of a cystic infection, i.e., increased inflammatory cells and presence of pathogens, leading to the definitive diagnosis [11]. When a cyst with septal-like structures is seen on US, hydatid cysts must be differentiated [12], but hemorrhage can also cause septal-like structures due to intracystic blood clots [13]. In our case, the drainage fluid was reddish brown, suggesting that the septal-like structures were caused by hemorrhage in combination with infection.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Cyst Infection Following Recurrent Biliary Obstruction in Polycystic Liver Disease

Miyagawa

NAKANO

Yoneda

et al. 2022

J UOEH

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An 89-year-old man with polycystic liver disease (PCLD) received uncovered self-expandable metallic stent (SEMS) placement above the papilla for malignant biliary obstruction caused by cholangiocarcinoma. He developed cholangitis ten months later due to SEMS occlusion caused by tumor ingrowth, and 2 plastic biliary stents were placed inside the SEMS across the papilla. Fever and right costal pain appeared two weeks after reintervention. Suspecting hepatic cyst infection based on imaging studies, percutaneous transhepatic cyst drainage was performed. Increased inflammatory cells and the presence of pathogens in the cyst fluid led to a definitive diagnosis of hepatic cyst infection. Following drainage, the hepatic cyst shrank with resolution of the symptoms. SEMS occlusiverelated cholangitis or retrograde infection due to duodenal-biliary reflux after reintervention was considered as the cause of the hepatic cyst infection. Careful clinical and imaging evaluation should be performed in patients with PCLD undergone biliary stenting, because cyst infection may occur following stent occlusion or subsequent biliary reintervention.

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Section: Discussionmentioning

confidence: 99%

Hepatic Cyst Infection Following Recurrent Biliary Obstruction in Polycystic Liver Disease

Miyagawa

NAKANO

Yoneda

et al. 2022

J UOEH

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“…However, it should be noted that attributing symptoms to simple cysts should be done with caution after ruling out all other possible causes. To manage simple hepatic cysts, it's important to correctly differentiate them from neoplasms and infections, and then choose a reliable treatment, including percutaneous aspiration, aspiration followed by sclerotherapy, or surgery [3]. Laparoscopic deroofing has become the preferred method due to its low recurrence rate, less postoperative complications, and exact efficacy [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

A safe and effective endoscopic treatment method for simple hepatic cysts (with video)

Chen,

Han,

Xiao

et al. 2024

Endosc Int Open

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Background Symptomatic simple hepatic cysts require treatment, with several guidelines recommending laparoscopic deroofing. However, cysts located in the posterosuperior segments are considered poor candidates for this procedure. Gastrointestinal endoscopes are more flexible and able to reach less accessible areas than laparoscopes. This study aimed to evaluate the utility of endoscopic transgastric hepatic cyst deroofing (ETGHCD) for treatment of simple hepatic cysts. Methods 7 patients with simple hepatic cysts were evaluated between June 2021 and October 2023. The success rate, procedure time, post-procedure length of hospital stays, complications, pathologic diagnosis, and efficacy were recorded. Results 11 cysts in 7 patients (5 men; mean age 65.5 (standard deviation [SD] 8.5) years) were successfully treated without any complications. The mean procedure time was 65.6 (SD 17.2) minutes. Mean post-procedure hospitalization was 4.4 (SD 1.0) days. The pathologic diagnosis of 11 cysts showed simple hepatic cysts. The size of cysts was significantly decreased from 337.0 (SD 528.8) cubic centimeters to 5.2 (SD 6.3) cubic centimeters 1 month after ETGHCD. During the median 12.7-month follow-up in 7 patients, the cysts showed a 99.6% reduction with no recurrence. Conclusions ETGHCD provided a feasible, safe, effective, and minimal invasive alternative approach for the treatment of simple hepatic cysts.

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“…Simple hepatic cysts (SHCs) are the most commonly diagnosed benign liver lesions, with a prevalence of 18 % in the general population undergoing abdominal computed tomography (CT) scanning for unrelated pathologies 1 . They are usually asymptomatic and detected incidentally, given the development and widespread use of diagnostic modalities 2 . However, larger lesions may present with clinical signs such as abdominal pain, epigastric fullness, early satiety or even jaundice.…”

Section: Introductionmentioning

confidence: 99%

“…However, larger lesions may present with clinical signs such as abdominal pain, epigastric fullness, early satiety or even jaundice. Infrequently, internal hemorrhage, infection, or rapid enlargement can lead to symptoms and presentation for clinical evaluation 2 .…”

Section: Introductionmentioning

confidence: 99%

EUS-guided endoscopic internal drainage with lumen-apposing metal stent for symptomatic hepatic cysts: a case series (with video)

D’Errico

Derhy²,

Fazi

et al. 2022

Endosc Int Open

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INTRODUCTION/AIM: Simple hepatic cysts (SHC) are usually asymptomatic and detected incidentally. However, larger cysts may present with clinical signs and require treatment such as percutaneous aspiration or surgery with non negligeable rate of recurrence. We report a series of 13 consecutive patients who underwent EUS guided Lumen Apposed Metal Stent (LAMS) drainage of symptomatic hepatic cysts of the right and left liver. METHODS: 9 Males, 4 Female, average age of 71.9 years underwent EUS guided LAMS cyst drainage because of significant symptoms. At one month, LAMS was changed for double pigtails stent (DPS) for three months. 9 were located in the right liver and four in the left. Diameter was on average 22,2 cm. RESULTS: 13 LAMS were successful delivered in all patients. However only in 12 out of 13 (92.3%) remained in place. In one case it slipped out immediately, was promptly removed and the cyst treated percutaneously. 1 out 12 presented bleeding and were treated conservatively. Only in 7 patients LAMS was removed for DPS, in the other 5 were successfully left in place until death given their comorbidities. At 10,5 months of follow up none recurred. CONCLUSION: EUS guided LAMS drainage permits treatment of symptomatic hepatic cysts without recurrence and with few adverse events. Studies of comparison are needed to consider this approach as first intention.

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Management of Simple Hepatic Cyst

Cited by 23 publications

References 57 publications

Hepatic Cyst Infection Following Recurrent Biliary Obstruction in Polycystic Liver Disease

Hepatic Cyst Infection Following Recurrent Biliary Obstruction in Polycystic Liver Disease

A safe and effective endoscopic treatment method for simple hepatic cysts (with video)

EUS-guided endoscopic internal drainage with lumen-apposing metal stent for symptomatic hepatic cysts: a case series (with video)

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