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Gastrointest Endosc. 2014 Dec;80(6):1014-21. doi: 10.1016/j.gie.2014.03.037. Epub 2014 Jun 2.

Ethanol lavage of huge hepatic cysts by using EUS guidance and a percutaneous approach.

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1
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

EUS-guided and percutaneous lavage therapy for large hepatic cysts can replace surgical drainage. EUS-guided therapy can especially enable the alcohol lavage to be done with a 1-step approach.

OBJECTIVE:

To evaluate the utility of EUS-guidance and percutaneous ethanol lavage therapy.

DESIGN:

Retrospective cohort study.

SETTING:

Tertiary-care referral teaching hospital.

PATIENTS:

Adult patients with large liver cysts who underwent cyst drainage and alcohol ablation between 2009 and 2012.

INTERVENTIONS:

Ethanol lavage via percutaneous and/or EUS-guided approaches.

MAIN OUTCOME MEASUREMENTS:

Feasibility, efficacy, and safety of ethanol lavage.

RESULTS:

Seventeen patients with 19 hepatic cysts were enrolled. The median cyst volume before therapy was 368.9 mL (interquartile range, 195.3-795.9 mL). Ten cysts were drained by the percutaneous approach with a pigtail catheter, and 8 cysts underwent EUS-guided aspiration and lavage treatment. In 1 case, both the percutaneous approach and EUS-guided puncture were used. During the median 11.5-month follow-up of the percutaneous approach group, the cysts showed 97.5% reduction. During the median 15-month follow-up of the EUS-guided group, the cysts showed nearly 100% reduction. Percutaneous catheter drainage ethanol lavage was more feasible for right-sided larger cysts, whereas the EUS-guided approach was useful for left-sided lobe cysts.

LIMITATIONS:

Single-center retrospective study.

CONCLUSION:

Excellent symptomatic and radiologic responses and long-term results were achieved with percutaneous catheter-guided and EUS-guided ethanol lavage. Ethanol lavage could be considered a primary method of treatment for hepatic cysts given its high degree of technical feasibility and safety.

PMID:
24890421
DOI:
10.1016/j.gie.2014.03.037
[Indexed for MEDLINE]
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