Successful Stepwise Endoscopic Ultrasound-Guided Cyst Drainage for a Giant Infected Hepatic Cyst: A Case Report

Area of Science:

• Gastroenterology
• Hepatology
• Interventional Endoscopy

Background:

• Giant hepatic cysts can cause significant complications, including biliary obstruction and infection.
• Management of infected hepatic cysts, especially large ones compressing vital structures, presents a clinical challenge.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic ultrasound-guided cyst drainage (EUS-CD) combined with internal stenting for managing a giant infected hepatic cyst.

Main Methods:

• A 79-year-old male with a giant hepatic cyst causing cholangitis underwent initial nasobiliary drainage.
• Endoscopic ultrasound-guided cyst drainage (EUS-CD) with nasocystic drainage was performed due to patient's poor condition and risk of percutaneous drainage.
• Internal trans-endoscopic ultrasound-guided created route (ESCR) drainage with double-pigtail stents was utilized after initial EUS-CD, with subsequent stent exchanges for recurrent infection.

Main Results:

• Initial EUS-CD and nasocystic drainage improved cholangitis.
• Conversion to internal trans-ESCR drainage with stenting resolved bile duct compression.
• Recurrent infection due to stent occlusion necessitated stent exchange and additional ESCR drainage, ultimately leading to sustained infection control with multiple plastic stents.

Conclusions:

• Endoscopic ultrasound-guided cyst drainage (EUS-CD) followed by internal stenting via the endoscopic ultrasound-guided created route (ESCR) is a safe, effective, and durable treatment for giant infected hepatic cysts.
• This minimally invasive approach is particularly valuable for patients unsuitable for percutaneous drainage or surgery due to anatomical complexities or poor general condition.