# Percutaneous aspiration and sclerotherapy for simple hepatic cysts: a systematic review and meta-analysis

## TL;DR

Percutaneous aspiration and sclerotherapy is a safe and effective treatment for simple hepatic cysts, providing high symptom relief with low complication rates.

## Contribution

This study provides a systematic review and meta-analysis of PAS for SHCs, highlighting its efficacy and safety profile.

## Key findings

- PAS achieved an 86.9% pooled rate of symptomatic relief or disappearance.
- Cyst volume reduction rate was 86.4%, though with high heterogeneity.
- Minor complications occurred in 13.6% for pain and 7.4% for fever.

## Abstract

This systematic review aims to assess the efficacy and safety of percutaneous aspiration and sclerotherapy (PAS) for patients with symptomatic simple hepatic cysts (SHCs).

We systematically searched the electronic databases of PubMed, Embase, the Cochrane Library and Ichushi-Web for studies published up to November 2024, reporting outcomes of PAS for symptomatic SHCs. The primary outcomes were rates of symptomatic relief or disappearance of symptoms. The secondary outcomes were cyst volume reduction rates and complication rates. Subgroup analyses compared ethanol with the other sclerosants. Single-arm meta-analyses were performed, with meta-regression conducted when substantial heterogeneity (I2 > 50%) was observed. Risk of bias was assessed using the Cochrane RoB2 tool for randomized controlled trials and RoBANS2 for non-randomized studies.

Sixteen studies were included. Fourteen studies were assessed as having a high risk of bias. The pooled symptomatic relief or disappearance rate was 86.9% (95% CI 80.2–91.6%, I2 = 0%). The cyst volume reduction rate was 86.4% (95% CI 74.1–93.3%, I2 = 95%). There were no major complications. The pooled minor complication rates were 13.6% (95% CI 6.5–26.4%, I2 = 67.2%) for pain and 7.4% (95% CI 4.1–13.0%, I2 = 38%) for fever. Subgroup analysis showed no significant differences between ethanol and other sclerosants. High heterogeneity was observed for cyst volume reduction and pain, indicating variability across studies. Meta-regression analysis for cyst volume reduction rate and pain did not identify any significant associations.

PAS appears to be a relatively safe and effective treatment option for patients with symptomatic SHCs and provides high rates of symptomatic relief with low complication rates. However, given the high risk of bias in the available evidence and the lack of direct comparison with surgical treatment, these findings should be interpreted with caution. Further high-quality comparative studies are warranted to confirm these results.

The online version supplementary material available at 10.1007/s11604-025-01874-7.