Comparison of CT-guided intracystic lidocaine pre-injection versus conventional US-guided single-session ethanol sclerotherapy for simple hepatic cysts

This study aimed to compare a modified CT-guided technique incorporating intracystic lidocaine for pain control versus a conventional ultrasound-guided method for single-session ethanol sclerotherapy of simple hepatic cysts (SHCs), to seek refinements in technical strategies. 113 patients with SHCs underwent ethanol sclerotherapy between January 2019 and June 2023 at two centers. Center A utilized a modified CT-guided technique with intracystic lidocaine pre-injection into the cyst. Center B employed a conventional ultrasound-guided method with pigtail catheter drainage. Primary endpoints included pain during ethanol injection, procedural duration, and safety, while secondary endpoints assessed cyst volume reduction and symptom relief. 99 eligible patients (Center A/B, n = 43/56) were included in the analysis. The modified technique at Center A resulted in significantly lower median VAS scores (1.2 ± 1.2) compared to Center B (5.1 ± 1.1; p < 0.01) during ethanol injection. Ethanol exposure and procedural durations were also shorter at Center A (11.2 ± 1.6 min and 29.9 ± 4.3 min) than at Center B (20.5 ± 3.4 min and 40.6 ± 4.2 min; p < 0.01). No complications were observed at Center A. Both centers achieved similar success rates in reducing cyst size and relieving symptoms at the 6-month follow-up. The modified CT-guided percutaneous single-session ethanol sclerotherapy technique for SHCs significantly reduces pain and procedural duration compared to the conventional method, with similar efficacy and safety profiles.