Top

European Radiology

Published in:

Open Access 01-06-2019 | Gastrointestinal

Symptom relief and not cyst reduction determines treatment success in aspiration sclerotherapy of hepatic cysts

Authors: Myrte K. Neijenhuis, Titus F. M. Wijnands, Wietske Kievit, Maxime Ronot, Tom J. G. Gevers, Joost P. H. Drenth

Published in: European Radiology | Issue 6/2019

Abstract

Objective

To assess whether quantitative assessment of symptom reduction is a better outcome parameter than cyst volume reduction for treatment success in patients treated by aspiration sclerotherapy.

Methods

We included patients with symptomatic, large (> 5 cm), hepatic cysts from a randomized controlled trial (NCT02048319). At baseline and 6 months after treatment, symptoms were assessed with the polycystic liver disease questionnaire (PLD-Q) and we measured cyst volume using ultrasonography. Patient-reported change in health was assessed on a 5-point Likert scale (much worse to much better) after 6 months. We tested whether PLD-Q scores and cyst volumes changed after aspiration sclerotherapy (responsiveness). Changes in PLD-Q scores and cyst volume were compared with change in health as a measure of treatment success (discriminative ability). As secondary analysis, we compared baseline characteristics between responders (improved) and non-responders (not improved).

Results

We included 32 patients. Six months after treatment, 23 patients (72%) improved. Both PLD-Q score and cyst volume significantly decreased (median 38 to 18 points, p < 0.001, and 479 to 68 mL, p < 0.001). Larger improvement in PLD-Q score was associated with a positive change in health (p = 0.001), while larger proportional reduction in cyst volume was not significantly associated with health improvement after treatment (p = 0.136). Responders had larger baseline cyst volumes compared to non-responders (median 624 mL [IQR 343–1023] vs. 322 mL [IQR 157–423] p = 0.008).

Conclusion

Cyst diameter reduction does not reflect treatment success in aspiration sclerotherapy from patients’ perspective, while symptoms measured with the PLD-Q can be used as a reliable outcome measure.

Key Points

• Cyst diameter reduction poorly reflects treatment success in aspiration sclerotherapy.

• Symptoms measured by the polycystic liver disease questionnaire (PLD-Q) is a better outcome measure than cyst volume reduction for treatment success after aspiration sclerotherapy.

• Particularly patients with larger cysts (≥ 529 mL) benefit from aspiration sclerotherapy.

Available only for authorised users

Lantinga MA, Gevers TJ, Drenth JP (2013) Evaluation of hepatic cystic lesions. World J Gastroenterol 19:3543–3554CrossRefPubMedPubMedCentral

van Aerts RMM, van de Laarschot LFM, Banales JM, Drenth JPH (2017) Clinical management of polycystic liver disease. J Hepatol. https://doi.org/10.1016/j.jhep.2017.11.024

Wijnands TF, Neijenhuis MK, Kievit W et al (2014) Evaluating health-related quality of life in patients with polycystic liver disease and determining the impact of symptoms and liver volume. Liver Int 34:1578–1583CrossRefPubMed

Drenth JP, Chrispijn M, Nagorney DM, Kamath PS, Torres VE (2010) Medical and surgical treatment options for polycystic liver disease. Hepatology 52:2223–2230CrossRefPubMed

Benzimra J, Ronot M, Fuks D et al (2014) Hepatic cysts treated with percutaneous ethanol sclerotherapy: time to extend the indications to haemorrhagic cysts and polycystic liver disease. Eur Radiol 24:1030–1038CrossRefPubMed

Tikkakoski T, Mäkelä JT, Leinonen S et al (1996) Treatment of symptomatic congenital hepatic cysts with single-session percutaneous drainage and ethanol sclerosis: technique and outcome. J Vasc Interv Radiol 7:235–239CrossRefPubMed

Yan-Hong F, Lin-Xue Q, Hai-Ma G, Qing Z, Yu G, Xiangdong H (2012) Sclerotherapy of simple hepatic cysts by repeated aspiration and alcohol instillation. Turk J Gastroenterol 23:359–365CrossRefPubMed

Wijnands TFM, Gevers TJG, Lantinga MA, Te Morsche RH, Schultze Kool LJ, Drenth JPH (2018) Pasireotide does not improve efficacy of aspiration sclerotherapy in patients with large hepatic cysts, a randomized controlled trial. Eur Radiol. https://doi.org/10.1007/s00330-017-5205-1

Wijnands TF, Görtjes AP, Gevers TJ et al (2017) Efficacy and safety of aspiration sclerotherapy of simple hepatic cysts: a systematic review. AJR Am J Roentgenol 208:201–207CrossRefPubMed

10.

van Keimpema L, Nevens F, Vanslembrouck R et al (2009) Lanreotide reduces the volume of polycystic liver: a randomized, double-blind, placebo-controlled trial. Gastroenterology 137:1661–1668.e1661–1662CrossRefPubMed

11.

Neijenhuis MK, Gevers TJ, Hogan MC et al (2016) Development and validation of a disease-specific questionnaire to assess patient-reported symptoms in polycystic liver disease. Hepatology 64:151–160CrossRefPubMed

12.

Bahirwani R, Reddy KR (2008) Review article: the evaluation of solitary liver masses. Aliment Pharmacol Ther 28:953–965PubMed

13.

Revicki D, Hays RD, Cella D, Sloan J (2008) Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol 61:102–109CrossRefPubMed

14.

EuroQol Group (1990) EuroQol–a new facility for the measurement of healthrelated quality of life. Health Policy 16:199–208

15.

Larssen TB, Rosendahl K, Horn A, Jensen DK, Rorvik J (2003) Single-session alcohol sclerotherapy in symptomatic benign hepatic cysts performed with a time of exposure to alcohol of 10 min: initial results. Eur Radiol 13:2627–2632CrossRefPubMed

16.

Terwee CB, Bot SD, de Boer MR et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42CrossRefPubMed

17.

de Vet HC, Ostelo RW, Terwee CB et al (2007) Minimally important change determined by a visual method integrating an anchor-based and a distribution-based approach. Qual Life Res 16:131–142CrossRefPubMed

18.

Wijnands TF, Ronot M, Gevers TJ et al (2017) Predictors of treatment response following aspiration sclerotherapy of hepatic cysts: an international pooled analysis of individual patient data. Eur Radiol 27:741–748CrossRefPubMed

19.

Willke RJ, Burke LB, Erickson P (2004) Measuring treatment impact: a review of patient-reported outcomes and other efficacy endpoints in approved product labels. Control Clin Trials 25:535–552CrossRefPubMed

20.

Rahimi K, Malhotra A, Banning AP, Jenkinson C (2010) Outcome selection and role of patient reported outcomes in contemporary cardiovascular trials: systematic review. BMJ 341:c5707CrossRefPubMedPubMedCentral

21.

Ware JE, Kosinski M (2001) SF-36® Physical & Mental Health Summary Scales: a manual for users of version 1. QualityMetric Incorporated, Lincoln

22.

Zerem E, Imamović G, Omerović S (2008) Percutaneous treatment of symptomatic non-parasitic benign liver cysts: single-session alcohol sclerotherapy versus prolonged catheter drainage with negative pressure. Eur Radiol 18:400–406CrossRefPubMed

Title: Symptom relief and not cyst reduction determines treatment success in aspiration sclerotherapy of hepatic cysts
Authors: Myrte K. Neijenhuis
Titus F. M. Wijnands
Wietske Kievit
Maxime Ronot
Tom J. G. Gevers
Joost P. H. Drenth
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5851-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Symptom relief and not cyst reduction determines treatment success in aspiration sclerotherapy of hepatic cysts

Abstract

Objective

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 6/2019

Minimizing individual variations in arterial enhancement on coronary CT angiographs using “contrast enhancement optimizer”: a prospective randomized single-center study

Simulator training improves ultrasound scanning performance on patients: a randomized controlled trial

Predicting response to somatostatin analogues in acromegaly: machine learning-based high-dimensional quantitative texture analysis on T2-weighted MRI

Ascites relative enhancement during hepatobiliary phase after Gd-BOPTA administration: a new promising tool for characterising abdominal free fluid of unknown origin

Incidence and endovascular treatment of severe spontaneous non-cerebral bleeding: a single-institution experience

Radiation dose and image quality in intraoperative CT (iCT) angiography of the brain with stereotactic head frames