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

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.