Endoscopic observation of a lumen of a large hepatic cyst with aspiration and ethanol sclerotherapy: Case report and literature review

INTRODUCTION AND IMPORTANCE: A large hepatic cyst cause abdominal bloating and other symptoms. Surgical deroofing or ethanol sclerosis has been reported as the treatment options. We have treated patients surgically. However, an experience with postoperative bile leakage prompted us to reexamine our treatment options. It has been reported that the cause of bile leakage is the connection between the hepatic cyst and the bile duct. Therefore, we planned to observe the lumen of the hepatic cyst by endoscopy to evaluate the bile duct connection. CASE PRESENTATION: An 82-year-old woman presented to our hospital for abdominal bloating. An abdominal computed tomography (CT) scan revealed a large hepatic cyst. Respiratory function was decreased due to diaphragmatic compression caused by the cyst. Endoscopic observation of the cyst was performed to evaluate the bile duct connection. There were no obvious abnormalities in her cyst. The patient was discharged 7 days after this procedure. CLINICAL DISCUSSION: Laparoscopic deroofing is recommended for the treatment of a large hepatic cyst when a patient can take surgery. However, deroofing has the potential for postoperative bile leakage. Careful consideration should be given to the treatment approach for each patient. Ethanol sclerotherapy has the potential for recurrence, but in this case, we confirmed the absence of bile duct connection. The ethanol sclerosis was effective, and there was no postoperative bile leakage. CONCLUSION: Endoscopic observation during puncture of the hepatic cyst allowed the evaluation of bile duct connection and search for malignant disease. Ethanol sclerotherapy was also effective.