From the Guidelines
Asymptomatic simple liver cysts do not require follow-up or treatment, regardless of size, as they typically follow an indolent course without significant changes in size over time. This is based on the most recent and highest quality study available, which provides evidence-based guidelines for the management of cystic liver diseases 1. The study suggests that simple hepatic cysts are benign lesions that do not require treatment unless they cause symptoms.
Key Points to Consider
- Simple hepatic cysts are benign and typically do not require treatment unless they cause symptoms 1.
- If patients become symptomatic, imaging (ultrasound first) will assess the size and look for complications and compression 1.
- Symptomatic hepatic cysts can be treated surgically or with percutaneous aspiration sclerotherapy 1.
- Aspiration sclerotherapy is a viable treatment option, with reported volume reductions ranging between 76-100% and symptom relief obtained in 72-100% of cases 1.
- Laparoscopic and open cyst deroofing/fenestration are associated with a low (<8%) recurrence rate 1.
Treatment Options
- Percutaneous aspiration sclerotherapy: a minimally invasive procedure that involves draining the cyst and temporarily exposing it to a sclerosing agent 1.
- Surgical removal: may be necessary in some cases, especially if the cyst is large or causing significant symptoms 1.
- Cyst fenestration: a procedure that involves draining the cyst and resecting the extrahepatic cyst wall 1.
Important Considerations
- It is essential to properly evaluate liver cysts to rule out other conditions like hydatid cysts or cystadenomas, which may have malignant potential.
- The majority of simple liver cysts develop from bile duct cells and contain clear fluid, and are more common in women, with prevalence increasing with age.
From the Research
Definition and Prevalence of Liver Cysts
- Liver cysts are congenital or acquired lesions that can be simple or complex in nature 2.
- The prevalence of simple liver cysts is estimated to be around 2.5%-4.25% 2.
- Liver cysts can be asymptomatic or symptomatic, with symptomatic cysts being rare and often large in size [(2,3)].
Diagnosis of Liver Cysts
- Imaging techniques such as ultrasound, CT, or MRI can be used to diagnose and characterize liver cysts [(2,3,4)].
- The differential diagnosis of liver cysts includes congenital, post-traumatic, benign or malignant tumors, as well as infectious pathologies 3.
Treatment Options for Liver Cysts
- Therapeutic abstention with or without iconographic monitoring is often the optimal management for benign liver cysts without clinical repercussions 3.
- Treatment options for symptomatic or potentially aggressive lesions may include fenestration, puncture with sclerotherapy, or surgical resection [(3,4,5)].
- Aspiration sclerotherapy is a percutaneous procedure that can be effective in treating symptomatic simple hepatic cysts 6.
- Minimally invasive management of liver cysts, including percutaneous drainage, laparoscopic fenestration, and laparoscopic hepatectomy, is an emerging field 4.
Complications and Safety of Treatment Options
- Postprocedural pain and ethanol intoxication are potential complications of aspiration sclerotherapy 6.
- The risk of bias in studies evaluating the efficacy and safety of aspiration sclerotherapy is often high 6.
- Careful patient counseling and assessment of symptom index is essential before embarking on any treatment for liver cysts 5.