Diagnostic and Interventional Radiology
Interventional Radiology - Original Article

Percutaneous sclerotherapy using a 4-F pigtail catheter and 40 milliliters of 5% ethanolamine oleate for symptomatic large hepatic cysts

1.

Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Funabashi, Wadanaka-cho, Japan

2.

Department of Internal Medicine, Fukui-ken Saiseikai Hospital, Funabashi, Wadanaka-cho, Japan

Diagn Interv Radiol 2020; 1: -
Read: 79 Published: 01 February 2021

PURPOSE: We retrospectively evaluated the efficacy of percutaneous sclerotherapy using a 4-F catheter and 40 mL of 5% ethanolamine oleate (EO) for symptomatic large hepatic cysts.
METHODS: Twenty-four patients, including 10 polycystic liver disease (PLD), were eligible. The mean long- and short-axis diameters of the cyst on computed tomography (CT) were 145.0 ± 35.5 (range: 72-216) and 110.5 ± 21.4 mm (range: 63-150), respectively. After aspiration of the fluid contents using a 4-F pigtail catheter, 40 mL of 5% EO was injected into the cyst for 30 minutes. Then, the catheter was withdrawn after EO removal. Symptomatic relief and complications were evaluated. The percentage reductions at the early (1-3 months later) and late (at the final follow-up) responses were evaluated using an estimated cyst volume calculated by using the following formula: volume = π/6 x long-axis diameter x (short-axis diameter)2 on the maximum cross-section image on CT. Spearman’s rank correlation coefficient (ρ) was used to evaluate the correlation between the pre-treatment estimated cyst volume and percentage reduction of early and late responses, and between the percentage reduction of the late response and length of the follow-up period after sclerotherapy.
RESULTS: The symptoms disappeared in 23 patients and was improved in one PLD. The mean aspirated fluid volume was 1337.8 ± 845.4 mL (range: 140–3200). In one patient, EO injection was postponed until the second procedure performed 40 days later due to intraperitoneal leakage of contrast material. In another patient, the EO volume was reduced to 20 mL because of a small cyst size. The mean early and late percentage reductions of the treated cyst were 52.3 ± 23.8% and 87.5 ± 20.4% (mean follow-up period: 48.0 ± 42.4 months), respectively. The symptom recurred in two PLD patients and one underwent additional sclerotherapy 14 months later due to re-enlargement of the treated cyst. Another patient underwent transarterial embolization 5 years and 4 months later for enlarged other cysts, although the treated cyst markedly shrank. There were significant negative correlations between the pre-treatment estimated cyst volume and percentage reduction of early (p = 0.027, ρ= -0.46) and late (p = 0.007, ρ = -0.52) responses. However, there were no significant correlations between the percentage reduction and length of the follow-up period (p = 0.19, ρ = 0.31). Transient pain developed in one patient and low-grade fever in three.
CONCLUSION: Sclerotherapy using a 4-F catheter and 40 mL of 5% EO is safe and effective for symptomatic large hepatic cysts.
 

EISSN 1305-3612