Single-session alcohol sclerotherapy in symptomatic benign hepatic cysts performed with a time of exposure to alcohol of 10�min: initial results

Abstract

The aim of this study was to evaluate the 1-year results of single-session sclerotherapy of symptomatic benign non-parasitic liver cysts performed with maximum 10 min time of ethanol exposure. During the period 1995-1999, 15 symptomatic liver cysts in nine patients--eight women and one man--were treated with 10 min time of exposure to ethanol. Ultrasound-guided puncture combined with fluoroscopy was used for catheter placement. Alcohol sclerotherapy was performed with a maximum volume of ethanol 96% of 10% of the cyst volume, never exceeding 100 ml. At follow-up the patients were examined with liver function tests, ultrasound or CT examination, clinical examination, and interview by a gastrointestinal surgeon. Ten cysts in seven patients (six women and one man; age range 44-61 years, median age 58 years), who had a follow-up of at least 1 year, were included. The original cyst volumes were 30-4110 ml (median 392 ml). After a follow-up period of 12-47 months (median 23 months), cyst volumes were 0-523 ml (median 21.5 ml) with a reduction of the median cyst volume by 95% ( p<0,005). All patients experienced relief of their clinical symptoms. Except for pain, no complications were observed. Sclerotherapy using only one session and maximum 10 min time of exposure to ethanol represents an effective treatment of symptomatic liver cysts.

Percutaneous treatment of symptomatic non-parasitic benign liver cysts: Single-session alcohol sclerotherapy versus prolonged catheter drainage with negative pressure

“…Their results suggest that multiple sclerotherapy is better than a single injection of sclerosant for reducing the recurrence rate of nonparasitic liver cysts. In other studies, single session alcohol sclerotherapy [6,8,17,18,22,23] was performed with good results. They recommend single-session alcohol sclerotherapy as a sufficient and less risky method.…”

“…Advances in minimally invasive percutaneous treatment have provided an opportunity to treat these cysts with aspiration of cystic fluid and injection of a sclerosing agent. The most common percutaneous treatment for symptomatic non-parasitic cysts is aspiration with alcohol sclerotherapy [6][7][8][9]; rarely other sclerosance is used [10][11][12][13][14][15][16]. Several authors consider that percutaneous cyst aspiration or drainage without sclerotherapy is not recommended because of frequent relapses [2,5,[17][18][19].…”

Sclerotherapy of simple hepatic cysts by repeated aspiration and alcohol instillation

“…In addition, because of incomplete aspiration of cyst fluid, the residual cyst fluid markedly dilutes the alcohol concentration, thus affecting its therapeutic efficacy (11). Therefore, there are increasing efforts to improve the outcome of alcohol sclerotherapy, including modulating ethanol concentration and volume, duration of ethanol exposure, and number of sclerotherapy sessions (12)(13)(14)(15)(16). For instance, insufficient alcohol concentration, volume, or short contact time with the cyst epithelia tends to result in a high recurrence rate (17), whereas an increased amount of alcohol or a longer exposure period may pose a higher risk of host toxicity (14).…”

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“…The longer the sclerosing time (retention time, reinjections), the lower the recurrence rate but the higher the complication rate. After ethanol sclerotherapy, an 80 -100 % reduction of cyst volume may be achieved [338,341,352,357,359,360]. The main complications during ethanol sclerotherapy are pain, ethanol-induced fever or hyperthermia, intoxication, intra-cystic bleeding and iatrogenic pleurisy or peritonitis [342,353].…”

“…Performing sclerotherapy in one session might be less effective for destroying the entire epithelium in comparison with prolonged drainage [338]. In ethanol sclerotherapy, different volumes (10 -50 % (as a rule "30 %") of the cyst volume, total volume < 200 ml), different ethanol concentrations (95 -99 %) were used and the sclerosing agent exposure time varied from 10 minutes (as a rule "30 minutes") to 4 hours [352,360]. The longer the sclerosing time (retention time, reinjections), the lower the recurrence rate but the higher the complication rate.…”