STS Sclerotherapy is Effective and Durable for Liver Cyst Volume Reduction in Autosomal Dominant Polycystic Kidney Disease

Sunday, March 5, 2023

4:03 PM – 4:12 PM

Location: Phoenix Convention Center, 225AB

Abstract Speaker(s)

RC

Ross Copping, MBBS BBiomedSc FRANZCR (he/him/his)

Interventional Radiology Fellow
University Health Network (University of Toronto)

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

ET

Elizabeth Tai, MD

Interventional Radiologist
University Health Network (University of Toronto)
Eran Shlomovitz, MD FACS

Surgeon Interventional Radiologist
Toronto General Hospital

Disclosure(s):

Ross Copping, MBBS BBiomedSc FRANZCR: No financial relationships to disclose

Purpose: Autosomal dominant polycystic kidney disease (ADPCKD) is associated with liver cysts in over 80% of patients. Large hepatic cysts may cause symptoms related to mass effect. Percutaneous sclerotherapy of hepatic cysts is a minimally-invasive treatment which may represent an alternative to more invasive surgical procedures. We present the results from our institution, using 3% Sodium Tetradechyl Sulphate (STS) foam for sclerotherapy of large symptomatic liver cysts.

Materials and Methods: 87 patients underwent percutaneous liver cyst sclerotherapy over an 8-year period (2014 to 2022). Using a standardised technique, a 6 Fr drainage catheter is inserted under sonographic guidance with position confirmed on fluoroscopy. Contrast injection ensures no extravasation and no biliary or vascular communication. The cysts are aspirated to dryness, allowing quantification of the cyst volume and optimal coating of the cyst walls. 3% STS foam is then injected (1:4 to 1:10 ratio of STS to room air). Large cysts ( >7cm) are treated in multiple sessions. Pre and post procedure magnetic resonance imaging (MRI) is used to assess volume response to treatment.

Results:
87 patients with 153 cysts were treated with 3% STS foam sclerotherapy. Of the analysed data, there was a 71.0% volume reduction on the first follow up study (preprocedure 316.4mL vs post procedure 91.9mL) (p< < 0.001). At a mean follow-up of 825 days, these cysts demonstrated a 71.9% volume reduction (preprocedure 343.6mL vs post procedure 96.5mL) (p< < 0.001). Cysts treated once had a 69.4% volume reduction (pre procedure 251.2mL vs post procedure 76.9mL) (p< < 0.001). Larger cysts requiring multiple treatments had 75% volume reduction (preprocedure 488.6mL vs post procedure 131.7mL) (p< < 0.001). The reported complication rate is low (< 5%).

Conclusion: 3% STS foam sclerotherapy is safe and effective for hepatic cyst volume reduction. Long term follow-up suggests a durable result in cysts that respond to treatment.