Sclerotherapy of simple hepatic cysts by repeated aspiration and alcohol instillation.

BACKGROUND/AIMS: The efficacy and safety of traditional alcohol sclerotherapy procedures are controversial in the management of large simple hepatic cysts. In this study, we aimed to develop and evaluate a novel alcohol sclerotherapy procedure, termed repeated aspiration and alcohol instillation sclerotherapy, for the treatment of simple hepatic cysts.

MATERIALS AND METHODS: A prospective, double-blind, randomized study was performed. Sixty-seven patients with large simple hepatic cysts were randomized into two groups to receive either single-session alcohol retention sclerotherapy (alcohol was instilled into the cyst cavity, kept for 20 minutes and aspirated) or repeated aspiration and alcohol instillation sclerotherapy (instillation of 30-70 ml of alcohol and immediate aspiration with repetition 3 to 6 times until the estimated alcohol concentration exceeded 80%). The cyst volume reduction was calculated to compare the efficacy of the two procedures. We evaluated the safety of the procedure by monitoring side effects and assaying blood alcohol concentrations at 0, 0.5, 1, 2 and 3 hours after sclerotherapy.

RESULTS: The cyst volume reduction in patients undergoing repeated aspiration and alcohol instillation sclerotherapy was significantly higher than that in those receiving alcohol-retention sclerotherapy. The concentration of alcohol in the last aspirated cyst fluid was correlated with the mean volume reduction in patients undergoing repeated aspiration and alcohol instillation sclerotherapy but not in the alcohol-retention group. Only minor side effects occurred in both groups. Although elevated blood alcohol concentration was noted in all patients, it declined to normal levels within 2-3 hours after treatment. There were no significant differences in blood alcohol concentration between the two groups.

CONCLUSIONS: Repeated aspiration and alcohol instillation sclerotherapy is superior to single-session alcohol-retention sclerotherapy in the management of large simple hepatic cysts.