Percutaneous US-guided combined ethanol and tetracycline injection for treating symptomatic simple and hydatid hepatic cysts

Abstract

Introduction: Percutaneous treatment of simple or hydatid liver cysts is widely used in clinical practice and ethanol is the commonest sclerosant used. Abdominal discomfort and pain commonly occurs after ethanol injection which increase with increased ethanol volume. Purpose: To evaluate the safety and efficacy of the combination of tetracycline and ethanol for percutaneous sclerotherapy of either symptomatic simple hepatic cysts or unilocular hepatic hydatid cysts. Patients and methods: A total of 34 adult patients with symptomatic simple cyst and 36 unilocular hydatid cysts underwent clinical, laboratory and radiological evaluations followed by diagnostic cyst aspiration. Each was divided into 2 arms. The first arm was treated by ethanol sclerotherapy and the second was treated by combined ethanol and tetracycline sclerotherapy. Results: Combined ethanol and tetracycline sclerotherapy was associated with fewer sessions than ethanol sclerotherapy (P = ≤0.001) and higher rate of sustained cyst size reduction on follow up (P = ≤0.001). Also second arm was associated with less pain than alcohol alone due to the beneficial effect of tetracycline. Conclusion: combined ethanol and tetracycline seems to be more effective, non expensive, more sustained action and more comfortable to our patients than single ethanol use. Keywords: Ethanol, Tetracycline, Simple hepatic cyst, Hydatid cyst, Combined sclerotherapy