Aspiration sclerotherapy of hepatic cysts

Hepatic cysts are fluid-filled lesions in the liver that generally arise as congenital anomalies. Prevalence is estimated between 3 and 18%. Overall, cysts are benign and asymptomatic. However, hepatic cysts can increase to a volume of several liters as a result of continuous fluid production by the cyst wall. This may lead to symptomatic disease due to mechanic pressure on surrounding organs and tissue. Treatment is indicated in these cases. Aspiration sclerotherapy is a minimally invasive procedure that includes percutaneous cyst drainage (aspiration) followed by injection of a sclerosing agent which destroys the epithelium of the cyst (sclerotherapy). This procedure results in cyst volume reduction aiming to relief the patient clinically. Since the early seventies, studies have been published with results of different approaches of aspiration sclerotherapy. Generally, these reports show high rates of efficacy and safety. Nevertheless, efficacy and safety remain source of debate and more invasive surgical alternatives are proposed as primary treatment strategy of large hepatic cysts. In the first part of this thesis, we focus on efficacy and safety of aspiration sclerotherapy. By systematically reviewing the literature, we found a median cyst volume reduction between 76 and 100%. Symptomatic relief is reached in 72 to 100% of patients. No severe morbidity or mortality is reported. In the second part of this thesis, we evaluate possible new modalities to optimize efficacy and safety of aspiration sclerotherapy. We have performed a randomized, placebo-controlled trial to evaluate the combined approach of aspiration sclerotherapy with a somatostatin analogue pasireotide. We found no beneficial effect in the pasireotide-arm. Finally, we explored penetration levels of the antibiotic drug cefazolin into hepatic cyst fluid. We observed low to absent concentrations of cefazolin in cyst fluid which suggests that cefazolin is inadequate as prophylaxis for postprocedural cyst infections after aspiration sclerotherapy