Foam Sclerotherapy for Symptomatic Cysts in ADPKD, ADPLD and Solitary Cysts.

Abstract

Background: This medical center migrated from alcohol to sotradecol foam sclerotherapy (SFS) because of perceived improved efficacy in managing symptomatic kidney and liver cysts. We report technical aspects, change in short and long-term cyst volumes, patient reported outcomes, safety, and applications of the technique.

Methods: In this retrospective observational study, cases from 1/2017-12/2021 had TKCV/TLCV (per Targeted Kidney or Liver or Cyst analysis) segmented using a deep-learning algorithm and cyst segmentation software (pre, post procedure and longitudinally). TKCV/TLCV percent change were evaluated using the 1-sample Wilcoxon signed rank test. For analyses involving changes in cyst volumes, the median percent change in cyst volume per patient was assessed. Longitudinal changes in cyst volumes were assessed using linear mixed models. Changes in quality of life (LASA, SF12, PLD-Q) were also assessed.

Results: There were 102 SFS sessions (38 kidney, 58 liver, 6 combined liver/kidney cysts) performed on 77 unique individuals included for analysis. Median [interquartile range, IQR] percent reductions in TKCV were-92.0% [IQR -98.2%, -82.7%, P<0.001) and for TLCV were -83.1% [IQR -93.5%, -52.9%, P<0.001). Among patients with multiple kidney procedures (n=7), median percent reduction in TKCV was -94.3% [IQR -96.6%, -92.4%, P=0.023]. For patients with multiple liver procedures (n=11), median percent reduction in TLCV was -63.3% [IQR -85.2%, -28.3%, P=0.004]. Results were similar among the 4 patients undergoing multi-stage procedures (n=1 kidney, n=3 liver). When measured longitudinally, both liver and kidney cyst volumes declined to levels near 0mL by 1 year follow-up and remained stable several years later. LASA physical domain and PLD-Q QOL scores improved post SFS procedure.

Conclusion: SFS led to substantial long-term reductions in TKCV/TLCV and improved QOL. SFS can augment cyst volume reduction in addition to tolvaptan (kidney cysts) and octreotide (liver cysts). In some individuals with large symptomatic cysts, multiple SFS procedures were safe and effective in reducing TLCV/TKCV and improving symptoms.