Repeated instillation of a limited volume of ethanol for the treatment of symptomatic hepatic cysts.
OBJECTIVE
In the past, various treatments for symptomatic hepatic cysts have been reported. In recent years, sclerosis therapy seems to be most common. In the present study, repeated instillation of a limited volume of ethanol was evaluated.


METHODS
Six patients who had one or more hepatic cysts underwent percutaneous alcohol sclerosis therapy. Of the six patients, five had epigastric discomfort, and one had back pain. A 7.0-French pigtail polyethylene catheter was inserted into the cyst. The fluid was aspirated and it was demonstrated by radiograph that there were no communications between the cysts and the intrahepatic duct or hepatic vessels. Six hepatic cysts were instilled with 99% sterile ethanol, which was allowed to remain in place for 5 minutes, and then removed. Ethanol instillation was repeated every day or every other day in all patients. It was performed two to five. Ethanol volume of a single instillation varied from 10mL to 100mL. In all cases, the ethanol volume of first instil lation was limited to 20mL or less to prevent severe complications.


RESULTS
The diameters of the initial cysts ranged from 7.8 to 13.2cm (mean, 10.4cm) and aspirated fluid volume varied from 70 to 1000mL (mean, 455mL). All patients had slight alcohol intoxication for a few hours after alcohol instillation, two had moderate abdominal pain at the time of alcohol instillation. In five of six patients, subtotal or total regression of the hepatic cysts was observed within eight months following treatment. In one case, the hepatic cyst was reduced from 13x11 to 7.8x7.5cm in size after seven months, but further regression was not obtained thereafter. All patients became symptom-free.


CONCLUSIONS
It is concluded that repeated instillation of a limited volume of ethanol is effective for the treatment of symptomatic hepatic cysts and potentially reduces the incidence of complications.
Department of General Surgery, Chiba University Graduate School of Medicine, Inohana, Chiba, Japan. kimura-f@umin.ac.jp
Fumio
F
Kimura
Masaru
M
Miyazaki
Hiroshi
H
Itoh
Toshikazu
T
Suwa
Toshiyuki
T
Sugiura
Tokuzou
T
Shinoda
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology; D003560:Cysts / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007322:Instillation, Drug; D008107:Liver Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012997:Solvents / Q000008:administration & dosage*
D012997:Solvents; D000431:Ethanol