LAUSR

Laparoscopic cystic fluid aspiration is one of the common treatments for polycystic liver disease (PLD) [1]. However, laparoscopes have limited flexibility, and parts of the abdominal cavity are difficult to reach [2]. To avoid the problem of laparoscope inflexibility, we use the more flexible endoscope to perform sclerotherapy for polycystic liver disease by means of natural orifice transluminal endoscopic surgery (NOTES). This is the first study to use NOTES sclerotherapy for polycystic liver disease. A 34-year-old woman presented with progressive epigastric distension, and was diagnosed with polycystic liver disease (▶Fig. 1). After informed consent was given, a NOTES procedure was performed (▶Video 1), with the patient under general anesthesia. The intestine was prepared in a routine fashion and sterilized, and a balloon-tube was placed in the descending colon to block the digestive juices. Using a hook-knife, an incision was made in the anterior wall of the sigmoid colon 18cm from the anus (▶Fig. 2). The endoscope was introduced into the abdominal cavity via the incision and reached the surface of the liver, where the liver cysts were visible. An endoscopic needle was used to drain sac fluid (▶Fig. 3) and a certain amount of foam sclerosing agent (lauromacrogol) was then injected (▶Fig. 4). Ultimately, nearly 500mL of sac fluid was extracted. Adhesions were released at the same time. After rinsing with normal saline, the incision was finally closed using clips. The procedure was performed successfully without any adverse events. The patient recovered well. Follow-up MRI after 3 months showed a 2-cm3 reduction in volume of the largest cyst (▶Fig. 5). The MRI signal values were significantly different compared with pre-NOTES. The patient’s liver function remains normal. NOTES sclerotherapy for polycystic liver disease is a novel technique and appears to safely preserve normal liver tissue. Further clinical studies with larger samples and long-term follow-up are needed to evaluate the effectiveness and safety of NOTES sclerotherapy for polycystic liver disease [3, 4].