<b>Purpose</b><br/>This study aims to investigate the clinical outcomes and safety of a standardized two-session catheter-directed ethanol sclerotherapy protocol for peritoneal inclusion cysts. <br/><b>Materials and Methods</b><br/>Between November 2020 and July 2025, six women (median age, 32.5 years) with symptomatic peritoneal inclusion cysts underwent ethanol sclerotherapy. After complete drainage using an 8.5-Fr or 10.2-Fr pigtail catheter, two sessions of sclerotherapy were performed on consecutive days. In each session, 99.5% ethanol (50% of the aspirated volume, up to 150 mL) was instilled and retained for 20 minutes. Follow-up ultrasound was performed at 1, 3, and 6 months. Technical success was defined as successful completion of both sessions with a 20-minute ethanol retention time, and clinical success was defined as symptom improvement with a >50% decrease in cyst diameter at 3 months. <br/><b>Results</b><br/>Technical success was achieved in all cases (6/6, 100%). The median maximum cyst diameter significantly decreased from 14.0 cm (range, 6.0 to 20.0 cm) to 5.25 cm (range, 2.0 to 8.0 cm) at the follow-up within 1 month (p = 0.03). Clinical success was achieved in all cases at 3 months (6/6, 100%). No residual cysts were visualized on follow-up ultrasound at 6 months in all patients (6/6, 100%). Anti-Müllerian hormone levels measured in four patients showed heterogeneous changes, precluding definitive conclusions regarding the impact on ovarian reserve. No major complications occurred. <br/><b>Conclusion</b><br/>Two-session catheter-directed ethanol sclerotherapy appears to be a safe and effective minimally invasive alternative to surgery for peritoneal inclusion cysts, providing a high rate of complete resolution.

Suture-mediated vascular closure devices (SMVCD) can be applied to close non-vascular structures, although this represents an off-label use. A 53-year-old woman who underwent hysterectomy and chemoradiation therapy due to endometrioid adenocarcinoma two years ago presented for generalized peritonitis due to anastomotic perforation following adhesiolysis and resection. CT revealed multifocal peritoneal abscesses. During perigastric fluid drainage, a pigtail drainage catheter was inadvertently placed into the stomach. To reduce the risk of gastroperitoneal fistula and peritonitis, the gastrostomy site was percutaneously closed using an SMVCD. Immediately after closure, gastrography using orally administered contrast medium and a 10-month follow-up CT demonstrated no leakage or procedure-related complications. This case suggests the potential for safe off-label use of vascular closure devices in the closure of gastrointestinal tract punctures.