Safety and efficacy of ultrasound-guided ethanol ablation for branchial cleft cysts: a retrospective multicenter case series

Abstract Background Branchial cleft cysts (BCCs) are congenital cervical anomalies traditionally managed by surgical excision, which carries risks of general anaesthesia, scarring, and cervical nerve injury. Ultrasound-guided percutaneous ethanol ablation (PEA) has emerged as a minimally invasive alternative. Published series on PEA for BCCs remain limited, and data from Southeastern Europe, North Africa, and the broader Middle East and Africa (SENAMEA) region are virtually absent from the literature. This study reports our multicentre institutional experience with PEA for second BCCs across two institutions in Egypt and Bosnia and Herzegovina. Methods We conducted a retrospective review of nine consecutive patients with ultrasound-confirmed, FNAC-proven benign second BCCs treated by PEA between 2022 and 2025. All patients had declined surgical intervention. Under ultrasound guidance, cysts were aspirated completely, irrigated with normal saline, and instilled with 95% sterile ethanol at a volume corresponding to approximately 70% of the aspirated fluid. Volume reduction rate (VRR) and complete response (defined as VRR ≥90% with clinical resolution) were assessed at 1, 3, 6, and 12 months. Results Nine patients (5 men, 4 women; mean age 33.8 ± 7.5 years) with a mean initial cyst volume of 26.5 ± 6.5 mL were included. A single ablation session was performed in all cases. The mean ethanol volume injected was 17.0 ± 4.3 mL. At 12-month follow-up, mean cyst volume was 1.3 ± 0.5 mL, corresponding to a mean VRR of 95.0 ± 1.0%. Complete response was achieved in all nine patients (100%). One patient (11.1%) experienced a minor transient complication (mild neck pain). No recurrences or major complications were recorded. Mean patient satisfaction was 4.9/5. Conclusion Ultrasound-guided PEA demonstrated high efficacy and an excellent safety profile in this preliminary series of nine patients with second BCCs. These findings support its further prospective evaluation as a minimally invasive alternative to surgery in selected patients. Larger controlled studies are needed before definitive recommendations can be made.