From the Guidelines
The treatment of a cyst should be guided by its type, location, size, and symptomatology, with a focus on minimizing morbidity, mortality, and improving quality of life, as outlined in the most recent guidelines from the Journal of Hepatology 1 and Kidney International 1. When considering treatment options for cysts, particularly in the context of polycystic liver disease (PLD), it's essential to weigh the benefits of intervention against the potential risks and complications.
- For asymptomatic simple hepatic cysts, no treatment or follow-up is recommended, as they typically follow a benign course 1.
- For symptomatic cysts, treatment options include percutaneous aspiration sclerotherapy, cyst fenestration, or surgical resection, depending on the cyst's characteristics and the patient's overall condition 1.
- In cases of polycystic liver disease, somatostatin analogues may be considered for severe, symptomatic hepatomegaly, while liver transplantation remains the only curative option for patients with massive PLD and high symptom burden or complications 1.
- Infected liver cysts require prompt antibiotic treatment, with consideration of percutaneous drainage or surgical intervention in cases of unresponsive pathogens, large infected cysts, or hemodynamic instability 1. The choice of treatment should be individualized, taking into account the patient's specific needs, symptoms, and quality of life, with the goal of providing effective relief while minimizing recurrence and complications.
- Aspiration sclerotherapy, for example, has been shown to provide symptomatic improvement in 72%-100% of cases, with minor complications occurring in 5%-90% of patients 1.
- Transarterial embolization and laparoscopic cyst fenestration are also viable options, with symptomatic improvement rates of 72%-93% and 66%, respectively, although they carry higher risks of complications and mortality 1. Ultimately, the treatment of a cyst should be guided by the most recent and highest-quality evidence, with a focus on optimizing patient outcomes and quality of life.
From the Research
Treatment of Cysts
The treatment of cysts varies depending on the type and location of the cyst.
- For functional ovarian cysts, studies have shown that combined oral contraceptives do not hasten resolution 2, 3.
- Expectant management, or watchful waiting, is often recommended for functional ovarian cysts, as most cysts resolve without treatment within a few cycles 2, 3.
- For simple renal cysts, treatment options include sclerotherapy, laparoscopy, and percutaneous endoscopic ablation 4.
- For neck cysts, treatment options include aspiration, surgery, and sclerotherapy, depending on the type and location of the cyst 5.
- The use of a levonorgestrel-releasing intrauterine system (LNG-IUS) has been shown to have a low incidence of ovarian cysts, with most cysts being functional in nature and resolving on their own 6.
Treatment Modalities
Different treatment modalities are available for the management of cysts, including:
- Sclerotherapy: a procedure where a sclerosing agent is injected into the cyst to shrink it 4, 5.
- Laparoscopy: a surgical procedure where a laparoscope is used to visualize and treat the cyst 4.
- Percutaneous endoscopic ablation: a procedure where a scope is inserted through the skin to visualize and treat the cyst 4.
- Aspiration: a procedure where the fluid is drained from the cyst 5.
- Surgery: a procedure where the cyst is removed surgically 5.
Factors Affecting Treatment Decision
The treatment decision for cysts depends on several factors, including: