Foam Sclerotherapy for a Symptomatic Hepatic Cyst: A Preliminary Report

Abstract

PurposeWe evaluated our initial experience of performing sclerotherapy for symptomatic hepatic cysts using polidocanol foam instead of a liquid sclerosant.MethodsThree consecutively registered patients with symptomatic hepatic cysts (one with polycystic liver disease) underwent polidocanol foam sclerotherapy. A pigtail catheter was inserted into the targeted cyst following percutaneous cyst puncture under ultrasound guidance, and the cyst fluid was aspirated. To confirm the absence of communications between the cyst and surrounding hepatic vessels, 3 % polidocanol foam sclerosant was injected at a 1:4 ratio of polidocanol to air following digital subtraction cystography with carbon dioxide. C-arm computed tomography (CT) guidance also was used to monitor foam filling of the targeted cyst. The maximum dose of sclerosant injected per treatment session did not exceed 10 ml. The catheter was kept unclamped overnight for open drainage, and additional sclerotherapy sessions were performed on subsequent days, if needed.ResultsEfficient sclerotherapy was achieved with an average of two sessions. The initial mean cyst volume was 1,052 ml, and gradual resolution was observed without recurrence. The mean reduction rate was 97.9 % (97.7–98.3 %), and all cyst-associated symptoms disappeared. The median follow-up period was 17 (range 6–21) months. Although one patient experienced moderate-grade fever and another moderate pain at the puncture site, no major complications were observed.ConclusionPolidocanol foam sclerotherapy is a safe and effective treatment for symptomatic hepatic cysts.

Ultrasound‐guided microfoam sclerotherapy with polidocanol for symptomatic giant hepatic cyst: Initial experience

“…Efficient sclerotherapy was achieved with an average of two sessions. As a result, the mean reduction rate was 97.9% (range, 97.7–98.3%) 6 months after microfoam sclerotherapy, with no major complications, similar to our study …”

“…Itou et al . reported in their preliminary study of polidocanol sclerotherapy for liver cyst that the mean 3% polidocanol dose used was 9.6 (range, 4–10) mL per session, and they mixed 2 mL of 3% polidocanol with 8 mL air . In case 1, we used 16 mL of 1% polidocanol with 32 mL CO 2 per session.…”

Foam Sclerotherapy for Cyst Volume Reduction in Autosomal Dominant Polycystic Kidney Disease: A Prospective Cohort Study

“…Visual inspection of the targeted kidney cysts showed no change in size up to 12 months postprocedure, suggesting permanent ablation of the targeted cysts in a majority of patients. [15][16][17] Although 13 (20%) patients reduced their MCIC risk class by at least 1 class and a small number of patients (6%) had a sustained improvement in creatinine clearance, these findings should be regarded as exploratory because our study was not formally designed to assess the treatment effect of foam sclerotherapy on kidney function. However, we found foam sclerotherapy to be safe and well tolerated with low risk for serious complications.…”

“…[11][12][13] It has also been compared with ethanol for ablation of simple kidney cysts, with similar success rates but less frequent pain. 14 We have used sodium tetradecyl sulfate foam sclerotherapy 15 for treatment of large symptomatic (≥5 cm in diameter) liver and kidney cysts in ADPKD. In this feasibility study, we examined the efficacy and safety of sodium tetradecyl sulfate foam sclerotherapy for experimental kidney volume reduction in ADPKD.…”

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“…The intra-cystic distribution of the sclerosing agent may be enhanced by using foam sclerosants (liquid sclerosants mixed with air). The advantage of foam sclerotherapy with polidocanol (10 mL of 3 %) has been demonstrated with hepatic cysts [347,361].…”