Ethanol lavage of huge hepatic cysts by using EUS guidance and a percutaneous approach

BackgroundEUS-guided and percutaneous lavage therapy for large hepatic cysts can replace surgical drainage. EUS-guided therapy can especially enable the alcohol lavage to be done with a 1-step approach.ObjectiveTo evaluate the utility of EUS-guidance and percutaneous ethanol lavage therapy.DesignRetrospective cohort study.SettingTertiary-care referral teaching hospital.PatientsAdult patients with large liver cysts who underwent cyst drainage and alcohol ablation between 2009 and 2012.InterventionsEthanol lavage via percutaneous and/or EUS-guided approaches.Main Outcome MeasurementsFeasibility, efficacy, and safety of ethanol lavage.ResultsSeventeen patients with 19 hepatic cysts were enrolled. The median cyst volume before therapy was 368.9 mL (interquartile range, 195.3-795.9 mL). Ten cysts were drained by the percutaneous approach with a pigtail catheter, and 8 cysts underwent EUS-guided aspiration and lavage treatment. In 1 case, both the percutaneous approach and EUS-guided puncture were used. During the median 11.5-month follow-up of the percutaneous approach group, the cysts showed 97.5% reduction. During the median 15-month follow-up of the EUS-guided group, the cysts showed nearly 100% reduction. Percutaneous catheter drainage ethanol lavage was more feasible for right-sided larger cysts, whereas the EUS-guided approach was useful for left-sided lobe cysts.LimitationsSingle-center retrospective study.ConclusionExcellent symptomatic and radiologic responses and long-term results were achieved with percutaneous catheter–guided and EUS-guided ethanol lavage. Ethanol lavage could be considered a primary method of treatment for hepatic cysts given its high degree of technical feasibility and safety.