Hepatic Cyst Sclerotherapy

Background and indications

Percutaneous hepatic cyst sclerotherapy is a minimally invasive treatment for symptomatic simple liver cysts (pain, compression of adjacent structures, functional impairment). Simple liver cysts are common (5-10% of population) but rarely symptomatic. Sclerotherapy is indicated for large cysts (> 5-10 cm) causing symptoms, as an alternative to surgical fenestration (marsupialization).

For hydatid cysts (echinococcosis), a specific technique (PAIR: Puncture-Aspiration-Injection-Reaspiration) with scolicide injection is used.

Pre-procedure assessment

Assessment includes ultrasound and/or CT/MRI to characterize the cyst (simple vs complicated, cystadenoma/cystadenocarcinoma exclusion), hydatid serology (if hydatid cyst suspected), and standard blood panel.

Procedure

Under local anesthesia and ultrasound guidance, a percutaneous drain (8-10F) is inserted into the cyst. Cyst contents are aspirated (sometimes several liters). A sclerosing agent (95% ethanol, 10-50% of aspirated volume, maximum 100 mL) is injected, left in contact 20-30 minutes with patient rotation, then reaspirated. For large cysts, the drain may be left in place 24-48h for sclerotherapy sessions. The procedure takes 30-60 minutes.

Results and scientific evidence

Success rate (volume reduction > 50% and symptom resolution) is 75-90% after 1-3 sessions. Long-term recurrence rate is 10-20%. The PAIR technique for hydatid cysts offers similar results to surgery with lower morbidity (Filice et al., World Journal of Gastroenterology, 2012).

Risks and complications

Abdominal pain (20-40%), vagal reaction (5-10%), cyst infection (< 3%), hemorrhage (< 2%). For hydatid cysts, anaphylactic shock risk is prevented by antihistamine premedication.

Recovery

Same-day discharge or 1 night hospitalization. Control ultrasound at 3 and 6 months.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by an interventional radiologist.