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. 2023 Jan 19;11(1):E76-E80.
doi: 10.1055/a-1968-7596. eCollection 2023 Jan.

EUS-guided endoscopic internal drainage with lumen-apposing metal stent for symptomatic hepatic cysts: a case series (with video)

Francesca DʼErrico  1   2 , Serge Derhy  1 , Maurizio Fazi  1 , Riccardo Memeo  3 , Francesco Decembrino  2 , Giovanni D De Palma  4 , Gianfranco Donatelli  1   4
Affiliations

EUS-guided endoscopic internal drainage with lumen-apposing metal stent for symptomatic hepatic cysts: a case series (with video)

Francesca DʼErrico et al. Endosc Int Open. .

Abstract

Background and study aims Simple hepatic cysts (SHCs) are usually asymptomatic and detected incidentally. However, larger cysts may present with clinical signs and require treatment such as percutaneous aspiration or surgery with non negligeable rate of recurrence. We report a series of 13 consecutive patients who underwent EUS-guided lumen-apposing metal stent (LAMS) drainage of SHCs of the right and left liver. Patients and methods Nine men and four women, average age 71.9 years, underwent EUS-guided LAMS cyst drainage because of significant symptoms. At 1 month, LAMS was exchanged for a double pigtail stent (DPS), which was left in place for 3 months. Nine of the SHCs were located in the right liver and four in the left. The average diameter was 22.2 cm. Results Thirteen LAMS were successful delivered in all patients. However only 12 of 13 (92.3 %) remained in place. In one case, the LAMS slipped out immediately and was promptly removed and the cyst treated percutaneously. One of 12 patients experienced bleeding, which was treated conservatively. In seven patients, the LAMS was exchanged for a DPS; in the other five, it was successfully left in place until the patients died, given their comorbidities. At 10.5 months of follow-up, none of the SHCs had recurred. Conclusions EUS-guided LAMS drainage permits treatment of symptomatic SHCs without recurrence and with few adverse events. Comparative studies are needed to consider this approach as first intention.

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Conflict of interest statement

Competing interests The authors declare that they have no conflict of interest.

Figures

Fig. 1 a, b
Fig. 1 a, b
CT scan showing right liver cyst > 20 cm in diameter.
Fig. 2 a, b
Fig. 2 a, b
X-ray showing LAMS in place, and at 1 month exchanged for double pigtails.
Fig. 3 a
Fig. 3 a
Endoscopic appearance of transgastric pigtail in place at 3 months. b Upper swallow study through the scope showing no extravasation of medium contrast, meaning that the cyst is completely resolved. On x-ray, the cavity was not visible anymore at the level of the pigtails.
See this image and copyright information in PMC

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