Symptomatic polycystic liver disease with hepatomegaly, in the absence of cyst hemorrhage or cyst infection. In symptomatic patients, the treatment goal is to reduce the volume of hepatomegaly, except for the two special cases of hemorrhage and infection.
Medical treatment with a somatostatin analogue (lanreotide, octreotide, or pasireotide) — aimed at reducing the volume of hepatic cysts and improving symptoms — did not achieve those targets. This protocol describes the next step taken after that failure.
For a selected large isolated cyst, a percutaneous interventional approach — combining cyst drainage and sclerosant instillation under imaging guidance — may produce significant clinical improvement. The complete eligibility criteria, procedural steps, and technical details are available in the full protocol.
Symptom relief, and reduction in the size of the treated cyst assessed at 6 months following the intervention.
In symptomatic patients, the treatment goal is to reduce the volume of hepatomegaly, except for the two special cases of hemorrhage and infection.
Sometimes isolated treatment of a large cyst (more than 5 cm) by needle puncture, evacuation of the cyst contents, and sclerosant injection may result in significant clinical improvement.
The cyst is evacuated, then filled with 95% alcohol to a maximum volume of 150 mL, followed by lateral tilting of the patient to allow the alcohol to contact all the cystic walls before re-aspiration of the sclerosing product.
It is quickly effective for symptom relief in 85% of cases, while the reduction in the size of the treated cyst is effective only 6 months after alcoholization.
DOI: 10.1016/j.jviscsurg.2018.07.004
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