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Year : 2017  |  Volume : 6  |  Issue : 7  |  Page : 7

Treatment of the large hepatic cysts by the ethanol retention therapy with endoscopic ultrasonography guidance and a percutaneous approach

Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2303-9027.212263

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Background and Objectives: Most hepatic cysts are asymptomatic with no need for treatment. However, large symptomatic hepatic cysts need treatment. Ultrasound-guided or computed tomography-guided percutaneous aspiration alone is less invasive, but this approach is associated with high recurrence. A surgical approach for these cysts provides satisfactory long-term outcomes, but it is associated with high perioperative morbidity and complication. The aim of the present study was to evaluate the utility of endoscopic ultrasonography (EUS) guidance and percutaneous ethanol retention for the treatment of symptomatic large benign liver cysts. Methods: Patients were treated by ethanol retention therapy from April 2009 to December 2016 in Asan Medical Center. Ethanol retention therapy through percutaneous and/or EUS-guided approaches was performed. Primary outcomes are feasibility, efficacy, and safety of ethanol lavage. Results: Forty-one patients with 51 hepatic cysts were enrolled. Thirty-one cysts were drained by the percutaneous approach with a pigtail catheter, and 22 cysts were aspirated with EUS guidance. In three cases, both the percutaneous approach and EUS-guided puncture were used. During the median 13-month follow-up of the percutaneous approach group, the cysts showed 100% reduction. During the median 15-month follow-up of the EUS-guided group, the cysts showed nearly 100% reduction. This is a single-center retrospective study. Conclusion: Percutaneous catheter-guided and EUS-guided ethanol retention therapy showed good radiologic responses, low adverse events, and great efficacy in large hepatic cyst. Both of these methods could be used as primary treatment of large hepatic cysts.

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