From the Guidelines
Symptomatic simple hepatic cysts in the right hepatic lobe should be treated with the best locally available volume-reducing therapy, such as percutaneous aspiration sclerotherapy or cyst fenestration, as recommended by the EASL clinical practice guidelines 1.
Treatment Options
- Percutaneous aspiration sclerotherapy: This involves draining the cyst and temporarily exposing it to a sclerosing agent, such as 100% ethanol, 20% saline, tetracycline, or polidocanol, with reported volume reductions ranging from 76-100% and symptom relief in 72-100% of cases 1.
- Cyst fenestration: This entails a laparoscopy, followed by drainage and resection of the extrahepatic cyst wall, with a low recurrence rate of less than 8% 1.
Important Considerations
- Aspiration of cyst fluid without subsequent sclerotherapy should not be considered as definitive volume-reducing therapy, as it invariably results in refilling of the cyst cavity with fluid 1.
- The volume reduction after aspiration sclerotherapy is slow in onset and may take at least 6 months, and reintervention should be avoided in the first 6 months after the procedure 1.
- Ultrasound should be the first imaging modality used to diagnose simple hepatic cysts, and further evaluation with additional imaging, such as MRI or CT, may be necessary for complex features or suspicious cysts 1.
- Routine follow-up with imaging after aspiration sclerotherapy or surgical procedures for hepatic cysts is not recommended, unless symptoms occur or there are concerns about complications 1.
From the Research
Treatment Options for Simple Cysts in the Right Hepatic Lobe
- Asymptomatic simple hepatic cysts do not require treatment 2
- Treatment for symptomatic simple hepatic cysts includes:
- Percutaneous aspiration
- Aspiration followed by sclerotherapy
- Surgery
- The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration due to its high success rate and low invasiveness 2
Percutaneous Treatment Options
- Simple drainage and drainage with sclerosing agents are percutaneous treatment options for symptomatic hepatic cysts 3
- Drainage with minocycline infusion may be a promising option for treating symptomatic hepatic cysts, with a lower relapse rate compared to simple drainage 3
- Ethanol lavage via percutaneous and/or EUS-guided approaches can be an effective treatment for large hepatic cysts, with excellent symptomatic and radiologic responses and long-term results 4
Comparison of Treatment Options
- Percutaneous aspiration and sclerotherapy (PAS) may be used as a less invasive alternative to surgical management for symptomatic simple hepatic cysts 5
- Outcomes of PAS for symptomatic SHC appear to be excellent, with low major complication rates and cyst recurrence rates 5
- Surgical excision is recommended in patients with larger cysts, causing pressure symptoms, or if the cyst size does not seem to involute with intractable abdominal pain or becomes complicated in the follow-up period 6