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

Abstract

BACKGROUND:

EUS-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.

OBJECTIVE:

To evaluate the utility of EUS-guidance and percutaneous ethanol lavage therapy.

DESIGN:

Retrospective cohort study.

SETTING:

Tertiary-care referral teaching hospital.

PATIENTS:

Adult patients with large liver cysts who underwent cyst drainage and alcohol ablation between 2009 and 2012.

INTERVENTIONS:

Ethanol lavage via percutaneous and/or EUS-guided approaches.

MAIN OUTCOME MEASUREMENTS:

Feasibility, efficacy, and safety of ethanol lavage.

RESULTS:

Seventeen 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.

LIMITATIONS:

Single-center retrospective study.

CONCLUSION:

Excellent 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.

• Authors: Seohyun Lee, Dong-Wan Seo, Woo Hyun Paik, Do Hyun Park, Sang Soo Lee, Sung Koo Lee, Myung-Hwan Kim
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 80 Issue 6 Pg. 1014-21 (Dec 2014) ISSN: 1097-6779 [Electronic] United States
• PMID: 24890421 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Chemical References

• Solvents
• Ethanol

Topics

• Ablation Techniques
• Aged
• Cohort Studies
• Cysts (therapy)
• Drainage
• Endosonography
• Ethanol (therapeutic use)
• Female
• Humans
• Liver (surgery)
• Liver Diseases (therapy)
• Male
• Middle Aged
• Retrospective Studies
• Solvents (therapeutic use)
• Therapeutic Irrigation (methods)
• Treatment Outcome
• Ultrasonography, Interventional