Exploratory application of endoscopic ultrasound-guided sclerotherapy in right renal cysts

Article information

Clin Endosc. 2025;.ce.2025.034

Publication date (electronic) : 2025 May 7

doi : https://doi.org/10.5946/ce.2025.034

Zhenyun Gong, Jialiang Huang, Wei Wu, Liming Xu, Duanmin Hu, Guilian Cheng

Department of Gastroenterology, Second Affiliated Hospital of Soochow University, Suzhou, China

Correspondence: Guilian Cheng Department of Gastroenterology, Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, China E-mail: 854235202@qq.com

Received 2025 January 30; Revised 2025 February 4; Accepted 2025 February 5.

Simple renal cysts require intervention when they exceed 4 cm or cause compressive symptoms.1 Although percutaneous aspiration with sclerotherapy is commonly used, cysts in the upper pole of the kidney pose challenges because of the lack of a safe pathway.2 Endoscopic ultrasonography (EUS)-guided sclerotherapy is a viable option for left renal cysts.3 The right kidney, which is slightly lower than the left kidney, is more difficult to access.

We report the case of a 35-year-old male with a 50 mm×51 mm right renal cyst causing persistent flank pain. Computed tomography revealed that the cyst was located at the upper pole of the right kidney and was obscured by the ribs, making percutaneous puncture difficult (Fig. 1). However, its proximity to the duodenum enabled EUS-guided sclerotherapy. Using EUS, the cyst was visualized posteriorly to the gastric body and punctured through the duodenal bulb using a 22-gauge needle (Fig. 2). Aspiration was initiated with low and gradually increasing negative pressure until the cyst collapsed completely. Finally, lauromacrogol, equivalent to one-third of the aspirated cyst fluid volume, was injected into the cyst cavity (Video 1). After the procedure, the patient received antibiotic therapy for 2 days, and no adverse events occurred.

Fig. 1.

Computed tomography image showing a 50 mm×51 mm cyst (asterisk) in the right kidney, located at the upper pole and obscured by the ribs.

Fig. 2.

Endoscopic ultrasonography probe positioned in the duodenal bulb; the cyst was clearly visualized and punctured using a 22-gauge needle.

Although left renal cysts are often incidentally observed during EUS evaluations of the pancreas, right renal cysts are less accessible. However, lesions in the upper pole of the right kidney, particularly those exceeding 5 cm, are easier to detect (either posterior to the gastric body or in the duodenal bulb) and puncture (via the duodenal bulb) (Fig. 3).

Fig. 3.

Large lesions in the upper pole of the right kidney can be detected either posterior to the gastric body or in the duodenal bulb and punctured through the duodenal bulb.

To the best of our knowledge, this is the first report of the application of this technique to treat right renal cysts. Our experience with five successful cases of EUS-guided sclerotherapy for right renal cysts (Table 1) demonstrates its safety and effectiveness as an alternative to percutaneous approaches, expanding possibilities for renal and urological interventions.

Table 1.

Five cases of endoscopic ultrasound-guided sclerotherapy for right renal cyst