Percutaneous sclerotherapy for simple hepatic cysts: a descriptive systematic review and proportional meta-analysis of single-arm studies

Percutaneous aspiration and sclerotherapy is a widely used treatment for symptomatic simple hepatic cysts, but the optimal sclerosing agent is unsettled and the literature consists almost entirely of single-arm studies, which cannot support valid between-agent comparison. We performed a descriptive systematic review and proportional meta-analysis restricted strictly to simple hepatic cysts (excluding polycystic liver disease), pooling outcomes within each agent rather than comparing agents. PubMed, Embase, and Cochrane CENTRAL were searched (1,237 records), yielding 25 included studies. Proportional outcomes were pooled with random-effects models on the logit scale (DerSimonian-Laird), with restricted maximum likelihood/Hartung-Knapp and continuity-correction-free (logistic-normal) sensitivity analyses. Prediction intervals and I² are reported, and subgroups of fewer than three studies are described rather than pooled. Symptomatic relief was high and consistent for the two adequately powered agents (ethanol 88.2% [95% CI 82.3-92.3; I²=36%; k = 9]; minocycline 90.3% [77.6-96.2; I²=0%; k = 5]) and similarly high in the two polidocanol/lauromacrogol series (88-100%). Complete radiographic obliteration was not summarizable (ethanol 53.7%, I²=95%, prediction interval 1-99%; polidocanol/lauromacrogol and minocycline each rested on two studies spanning roughly 23-94%). Minor complications differed numerically (polidocanol/lauromacrogol 7.9%, ethanol 19.8%, minocycline 24.1%) but with wide, overlapping intervals. Major procedure-related events were rare but did occur, including one ethanol intoxication with respiratory failure, one hepatic abscess, and one suspected chemical peritonitis. Recurrence, reported over widely varying follow-up, was low but is time-dependent and is presented descriptively rather than as a durability ranking. Symptom relief, not obliteration, is the reproducible and decision-relevant outcome. Agent differences in tolerability and durability are numerical and unconfirmed, so agent selection can reasonably be individualized by operator experience and patient priorities pending randomized trials.