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.