From the Guidelines
The management of an overfilled cyst typically involves drainage through aspiration or surgical intervention, with the best approach being percutaneous aspiration sclerotherapy or cyst fenestration as volume-reducing therapy, as recommended by the most recent guidelines 1. The choice of treatment depends on the cyst location, size, symptoms, and whether infection is present. For symptomatic cysts, percutaneous aspiration sclerotherapy is often the first-line approach, where a healthcare provider inserts a fine needle into the cyst to withdraw fluid and then injects a sclerosing agent to reduce the cyst volume, with reported volume reductions ranging between 76-100% and symptom relief in 72-100% of cases 1.
- Key considerations for treatment include:
- The use of sclerosing agents such as 100% ethanol, 20% saline, tetracycline, or polidocanol, with no clear evidence for superiority of any of the agents 1
- The importance of avoiding mere aspiration of cyst fluids without subsequent sclerotherapy, as this invariably results in refilling of the cyst cavity with fluid 1
- The potential for surgical intervention, such as laparoscopic or open cyst deroofing/fenestration, which is associated with a low recurrence rate of less than 8% 1
- The need to consider the risk of potential complicating effects of adhesions at the time of a future liver transplantation when considering cyst fenestration 1
- The role of liver transplantation as the only curative option for patients with polycystic liver disease (PLD) 1
From the Research
Management of Overfilled Cysts
The management of overfilled cysts depends on the type and location of the cyst, as well as the symptoms it is causing.
- For simple renal cysts, percutaneous aspiration alone or with sclerotherapy is often the first-line treatment 2, 3.
- Surgical decortication is generally reserved for recurrent or very large symptomatic cysts 2.
- Laparoscopic surgery is highly efficacious and is associated with high satisfaction rates with minimal morbidity 2.
- For hepatic cysts, aspiration sclerotherapy has been shown to be effective in reducing cyst size and symptoms 4.
- In cases of cystic ovarian tumors, a surgical technique involving covering the cyst with a sterilized surgical sheet and puncturing it can help prevent spillage of cyst fluid 5.
- For Baker's cysts, bedside ultrasound-guided aspiration and corticosteroid injection can be a safe and effective treatment option 6.
Treatment Options
Treatment options for overfilled cysts include:
- Percutaneous aspiration
- Sclerotherapy
- Surgical decortication
- Laparoscopic surgery
- Aspiration with corticosteroid injection
- Use of a sclerosing agent to reduce cyst size and symptoms 3
Considerations
When managing overfilled cysts, it is essential to consider the size of the cyst, as well as the symptoms it is causing 3.
- Cyst size should be taken into account when discussing treatment options.
- The use of a sclerosing agent can be integral to treatment success, but the optimum agent, volume, injection frequency, and dwelling time are yet to be defined 3.