Korean J Pancreas Biliary Tract.  2025 Jan;30(1):1-9. 10.15279/kpba.2025.30.1.1.

Management of Simple Hepatic Cyst: Is It Time to Change Our Paradigm to Early Non-Surgical Intervention?

• Alghazal RM
• Seo DW

• KMID: 2564034
• DOI: http://doi.org/10.15279/kpba.2025.30.1.1

Abstract

Hepatic simple cysts are common benign liver lesions frequently encountered in clinical practice. While the majority are asymptomatic and detected incidentally during imaging, approximately 5% of patients may experience symptoms, often related to the size and location of the cysts or the development of complications. Management of symptomatic cysts may involve percutaneous or endoscopic ultrasound (EUS)-guided aspiration with sclerotherapy, or surgical intervention, aimed at alleviating symptoms by reducing cystic volume. Solely aspirating cystic fluid tends to lead to complete cyst recurrence. Given the high recurrence rate, various management strategies have been proposed varying primarily in the choice of sclerosing agent (e.g., ethanol, tetracycline, polidocanol), infused volume, and retention time. Generally, these studies indicate good symptom improvement, reduced cyst volume, and a favorable safety profile. This review aims to revise the management approach for simple hepatic cysts by introducing two key changes based on recent practices. First, it advocates for a proactive management strategy, suggesting that intervention should not be delayed until cysts become symptomatic. Untreated growing cysts can lead to complications, making noninvasive management more challenging and increasing the likelihood of surgical intervention. Second, the review supports the use of sclerotherapy–either EUS-guided or percutaneous–as the first-line therapy for simple hepatic cysts, based on evidence demonstrating its effectiveness and safety. By addressing these changes, the review seeks to enhance current management strategies for simple hepatic cysts.

Keyword

Endosonography; Ethanol; Sclerotherapy; Liver cyst; 내시경초음파; 에탄올; 경화술; 간낭종