Treatment of symptomatic hepatic cysts by percutaneous instillation of minocycline hydrochloride

Abstract

Nine patients with 16 symptomatic nonneoplastic congenital hepatic cysts were treated prospectively by ultrasonically guided percutaneous minocycline hydrochloride injection, and the usefulness of this treatment was evaluated. Seven of the patients had multiple hepatic cysts, and two solitary cysts. All the patients were women, ranging in age from 36 to 81 years. After cystic fluid had been aspirated with a 21-gauge PTC needle, minocycline hydrochloride was injected into all the cysts. The minocycline hydrochloride was dissolved in saline at a concentration of 200 mg in 9 ml, and mixed with 1 ml of 2% mepivacaine hydrochloride. The total quantity of minocycline hydrochloride injected varied from 100 mg to 1200 mg per hepatic cyst, depending on its size. Total or subtotal regression of the cysts was observed in all patients during follow-up periods ranging from 15 to 35 months. Seven patients became symptom-free, one showed symptom reduction, and one showed no change in symptoms. Minor side effects, eg, transient abdominal pain, slight right shoulder pain, and temperature elevation, were noted in three patients respectively. On the basis of these results, we conclude that ultrasonically guided percutaneous minocycline hydrochloride injection is useful for the treatment of symptomatic hepatic cysts.

Medical and surgical treatment options for polycystic liver disease1

“…These latter agents destroy the cyst wall by the low pH that is created in the cyst. 34,35 The volume of ethanol used varies from 10% to 25% of the volume of aspirated cyst fluid (Fig. 3).…”

Repeated Minocycline Hydrochloride Injections for Symptomatic Polycystic Liver Disease

“…Both of these forms of PLD have an autosomal dominant pattern of inheritance [55] . There are various treatments for symptomatic hepatic cysts, such as cyst aspiration sclerotherapy [26,27,30,[35][36][37][38][39][40][41][42][43][44][45] , cyst fenestration (deroofing) [28,46] , liver resection [32][33][34]47] , hepatic arterial embolization [29] , and transplantation [31] . These treatments do not alter the natural course of the disease.…”

“…Among nonsurgical treatments, a 100% recurrence rate has been reported after cyst aspiration alone; an alternative method of treatment is thus required [65] . The instillation of various sclerosing agents has been used to obliterate symptomatic congenital hepatic cysts [26,27,30,[35][36][37][38][39][40][41][42][43][44][45] . Aspiration sclerotherapy involves cyst aspiration followed by the injection of a sclerosing agent, which destroys the epithelial cells lining the cyst cavity.…”

“…A low concentration of MINO (1 to 2 mg/mL) is usually injected intravenously. MINO injection has been used to treat renal cysts [66][67][68] , splenic cysts [69] , thyroid cysts [70] , and hepatic cysts [26,27,38,[41][42][43] . MINO 100 mg/mL was injected to treat thyroid cysts [70] , and MINO 10 mg/ mL [66] was instilled into renal cysts.…”

“…MINO 100 mg/mL was injected to treat thyroid cysts [70] , and MINO 10 mg/ mL [66] was instilled into renal cysts. Concentrations of MINO that have been used to manage hepatic cysts range from 5 to 50 mg/ mL [26,27,38,[41][42][43] . The efficacy of MINO injection is related to the extremely low pH of the tetracycline in solution, which destroys the mesothelial cells secreting the effusion, leading to involution of the cyst.…”