Percutaneous ethanol aspiration and ethanol injection (PAI) in the treatment of hydatid liver cysts (HLCs): 17-year experience of a single centre

Objectives: The aim of our study was to report our 17-year experience in the treatment of HLCs with double percutaneous aspiration and ethanol injection (D-PAI).

Methods: Between January 1988 and January 2005, 168 patients (108 males, 13–80 years) with 225 hydatid liver cysts underwent Double PAI. Only patients with viable cysts were treated. Under ultrasonographic guidance, the cystic fluid was aspirated as much as possible through 22–18G needles, and then 95% sterile ethanol was injected and left in situ without reaspiration. The same procedure was repeated 3 days later.

Results: D-PAI was completed in 106/110 (96.3%) patients with 151 viable HLCs. In 2 cases the procedure could not be completed because of intracystic hemorrhage (1 patient), and death following anaphylactic shock (1 patient). A total of 671 punctures were performed, the ethanol injected per-session ranged between 12 and 250ml. The overall median follow-up was 48 months. After completion of the procedure, on Ultrasound, 72/151 cysts (47.6%) desappeared, and 79/151 showed a decreased volume from 50 to 80%: 69/151 (45.8%) had a solid pattern and 10/151 (6.7%) had a minimal liquid component but without viable scolices. Intracystic relapse occurred in 6/151 (4%) HLCs. In no case new cysts were observed either in different hepatic segments or in any extrahepatic location. The morbidity rate was 8.6% and mortality rate 0.9%.

Conclusion: Over a long period, double percutaneous aspiration and injection of alcohol has proved to be a safe, effective, and low-cost procedure for hydatid liver cyst treatment.