To investigate the treatment and prevention of biliary tract injury following absolute ethanol sclerotherapy for large liver cysts.

From January 2009 to December 2020, 30 patients with large liver cysts (with a maximum cross-sectional length ≥10 cm) treated with ultrasound-guided percutaneous absolute ethanol sclerotherapy at Beijing Tiantan Hospital affiliated to Capital Medical University were included in this study, including one patient with polycystic liver disease. Absolute ethanol was used for the sclerotherapy of liver cysts via needle aspiration or catheter drainage. In patients treated with catheter drainage and sclerotherapy, the amount and color of cyst drainage fluid and the extubation time were recorded after treatment. The main complications and long-term efficacy of sclerotherapy for large liver cysts were analyzed.

Thirty patients with 30 large liver cysts were treated with ultrasound-guided percutaneous absolute ethanol sclerotherapy, of whom 3 patients underwent needle aspiration and sclerotherapy and 27 underwent catheter drainage and sclerotherapy. The maximum cross-sectional length of the 30 cysts was 10-18 cm, a total of 400 ml to 2500 ml of light yellow or clear fluid was extracted from each cyst, and 200ml to 300 ml of absolute ethanol was injected into each cyst cavity during one session of sclerotherapy, which was divided into 4-6 injections. Among 27 patients treated with catheter drainage and sclerotherapy, the indwelling time of the drainage tube was 3-5 days in 26 patients and 10 days in 1 patient. Two patients (6.7%) had excessive intracapsular hemorrhage during treatment, and the bleeding stopped spontaneously due to compression of the drainage tubes. Three patients (10.0%) developed biliary tract injury after sclerotherapy, who were treated with catheter drainage and the catheters were removed until bile leakage stopped; the extubation time was 3 days, 2 weeks and 3 months, respectively, and the three patients' cysts were completely or mostly absorbed without recurrence. Of the 30 patients included, 29 received one session of sclerotherapy and 1 received two sessions of sclerotherapy. With a median follow-up period of 15 (range 13-64) months in 30 patients, the total effective rate was 100% (30/30), and the cure and significant effective rate was 76.7% (23/30).

There is an increased risk of biliary tract injury following absolute ethanol sclerotherapy for large liver cysts adjacent to primary or secondary bile ducts. Catheter drainage with sclerotherapy is helpful to prevent and detect early biliary tract injury. Bile containing cyst and biliary tract injury following sclerotherapy are likely to be cured by catheter drainage, which should be given sufficient observation time.