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Akhan O. Percutaneous treatment of liver hydatid cysts: to PAIR or not to PAIR. Curr Opin Infect Dis 2023; 36:308-317. [PMID: 37548385 DOI: 10.1097/qco.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW The aim is to review recent literature for percutaneous treatment of liver hydatid cysts (cystic echinococcosis: CE) via different techniques such as PAIR (puncture, aspiration, injection, and reaspiration), standard catheterization, and modified catheterization technique (MoCaT). RECENT FINDINGS PAIR is an established technique and considered to be safe and effective for CE1 and CE3a as it is associated with lower morbidity, mortality, recurrence, and shorter hospital stay as compared with surgery. Standard catheterization is also dedicated for the treatment of CE1 and CE3a. PAIR should be preferred for treatment of liver CE1 and CE3a cysts, since PAIR is associated with lower major complication rates and shorter hospital stay. However, standard catheterization technique is indicated when cysto-biliary fistula develops or any technical difficulty arises during the PAIR. In these cases it is needed to switch PAIR to standard catheterization to complete the procedure. SUMMARY For CE1 and CE3a cysts, PAIR and standard catheterization are the choice for percutaneous treatments, while MoCaT is a treatment option for CE2 and CE3b cysts.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
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Pompili M, Ardito F, Brunetti E, Cabibbo G, Calliada F, Cillo U, de Sio I, Golfieri R, Grova M, Gruttadauria S, Guido M, Iavarone M, Manciulli T, Pagano D, Pettinari I, Santopaolo F, Soresi M, Colli A. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part I - Cystic lesions. Dig Liver Dis 2022; 54:1469-1478. [PMID: 36089525 DOI: 10.1016/j.dld.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/29/2022]
Abstract
Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.
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Affiliation(s)
- Maurizio Pompili
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy.
| | - Francesco Ardito
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Cliniche, Chirurgiche, Diagnostiche e Pediatriche, IRCCS Fondazione Ospedale San Matteo, Università di Pavia, Unità di Malattie Infettive e Immunologia, Pavia, Italy
| | - Giuseppe Cabibbo
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Fabrizio Calliada
- Dipartimento di Radiologia, Fondazione Policlinico San Matteo IRCCS, Università di Pavia, Italy
| | - Umberto Cillo
- Chirurgia Epatobiliare e Trapianto di Fegato, Ospedale Universitario di Padova, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Facoltà di Medicina e Chirurgia, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Rita Golfieri
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Mauro Grova
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Salvatore Gruttadauria
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMCI, Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, Università di Catania, Palermo, Italy
| | - Maria Guido
- Dipartimento di Anatomia Patologica, Azienda ULSS2 Marca Trevigiana, Treviso, Italy; Dipartimento di Medicina - DIMED, Università di Padova, Italy
| | - Massimo Iavarone
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tommaso Manciulli
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Duilio Pagano
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMC, Palermo, Italy
| | - Irene Pettinari
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Santopaolo
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Maurizio Soresi
- Medicina Interna, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Öztürk G, Uzun MA, Özkan ÖF, Kayaalp C, Tatlı F, Eren S, Aksungur N, Çoker A, Bostancı EB, Öter V, Kaya E, Taşar P. Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE). Turk J Surg 2022; 38:101-120. [PMID: 36483170 PMCID: PMC9714645 DOI: 10.47717/turkjsurg.2022.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association. MATERIAL AND METHODS This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach. RESULTS Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed. CONCLUSION The expert panel made recommendations for every topic.
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Affiliation(s)
- Gürkan Öztürk
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Mehmet Ali Uzun
- Clinic of General Surgery, Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Türkiye
| | - Ömer Faruk Özkan
- Clinic of General Surgery, Ümraniye Education and Research Hospital, İstanbul, Türkiye
| | - Cüneyt Kayaalp
- Department of General Surgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye
| | - Faik Tatlı
- Department of General Surgery, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Suat Eren
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Nurhak Aksungur
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ahmet Çoker
- Clinic of General Surgery, Medicana International İzmir Hospital, İzmir, Türkiye
| | | | - Volkan Öter
- Clinic of Gastroenterological Surgery, Ankara State Hospital, Ankara, Türkiye
| | - Ekrem Kaya
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Pınar Taşar
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
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Risk factors determining bile leakage after multiple liver hydatid cyst surgery. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1072054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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TURGUT B, BARAN N. CE1 ve CE3a karaciğer kist hidatiklerinin perkütan tedavisinde modifiye Seldinger ve trokar yöntemlerinin karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.675478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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TURGUT B. CE2 Tipi Karaciğer Kist Hidatik Lezyonlarının Modifiye Kateterizasyon Yöntemi ile Tedavisinde 8 F ve 14 F Kateterlerin Kullanımının Karşılaştırılması. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.755757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Aim: Hydatid cystic disease is an endemic parasitic disease that is common in the world. We aimed to review the demographic, clinical and laboratory findings, and treatments and outcomes of children with hydatid cyst disease, and to determine the factors affecting treatment response in two pediatric pulmonology centers in the central region of Turkey. Material and Methods: The clinical records of patients aged below 18 years who were followed up between January 2006 and December 2016 because of hydatid cyst disease were reviewed retrospectively. The patients’ ages at the time of diagnosis, sexes, living areas (rural /urban), dog contact history, presence of hydatid cyst in other family members, symptoms, organs involved, dimensions of cysts, laboratory results, treatments and post treatment responses, follow-up, and outcomes were noted. Results: In a period of 10 years, 50 pediatric patients were followed up with a diagnosis of hydatid cyst. The mean age was 9.3±0.5 years and 33 (66%) of the patients were male. Fifteen patients were living in a rural area and 35 were living in an urban area. Fifteen patients had a history of contact with a dog and 10% had a positive family history. Thirty-six patients had lung involvement, 25 had liver involvement, 14 (28%) had both lung and liver involvement, and six patients had organ involvement other than lung and liver. The indirect hemagglutination test for hydatid cyst was positive in 24 of 40 patients and Echinococcus granulosus-specific IgE positivity was detected in 8 of 17 patients. Surgery was performed in 31 patients with lung involvement and PAIR was performed in 13 patients who had liver involvement. Cyst excision was performed in two patients who had isolated spinal involvement. All patients were treated with albendazole, and additional praziquantel treatment was given to seven patients. Relapse occurred in seven patients in this period. The relapse frequency was higher in patients who had organ involvement other than in the lung and liver (p<0.05), and these patients’ treatment durations were longer compared with the others (p<0.05). Conclusion: Hydatid cysts can involve different organs in children. Patients with organ involvement other than the lung and liver should be followed up carefully in terms of recurrence.
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Sokouti M, Sadeghi R, Pashazadeh S, Abadi SEH, Sokouti M, Ghojazadeh M, Sokouti B. A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures. Arch Med Sci 2019; 15:284-308. [PMID: 30899281 PMCID: PMC6425195 DOI: 10.5114/aoms.2018.73344] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an academic debate over surgical treatments of liver hydatid cyst disease. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts. MATERIAL AND METHODS We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes. RESULTS Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. However, the recurrence rate is low in laparoscopic approaches. Moreover, Egger's tests for determining publication bias and heterogeneity tests were also performed. CONCLUSIONS This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates; however, the latter has a lower recurrence rate.
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Affiliation(s)
- Massoud Sokouti
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Pashazadeh
- Department of Computer and Electrical Engineering, University of Tabriz, Tabriz, Iran
| | - Saeed Eslami Hasan Abadi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sokouti
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Brunetti E, Tamarozzi F, Macpherson C, Filice C, Piontek MS, Kabaalioglu A, Dong Y, Atkinson N, Richter J, Schreiber-Dietrich D, Dietrich CF. Ultrasound and Cystic Echinococcosis. Ultrasound Int Open 2018; 4:E70-E78. [PMID: 30364890 PMCID: PMC6199172 DOI: 10.1055/a-0650-3807] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/25/2018] [Accepted: 06/18/2018] [Indexed: 02/08/2023] Open
Abstract
The introduction of imaging techniques in clinical practice 40 years ago changed the clinical management of many diseases, including cystic echinococcosis (CE). For the first time cysts were clearly seen before surgery. Among the available imaging techniques, ultrasound (US) has unique properties that can be used to study and manage cystic echinococcosis. It is harmless, can image almost all organs and systems, can be repeated as often as required, is portable, requires no patient preparation, is relatively inexpensive and guides diagnosis, treatment and follow-up without radiation exposure and harm to the patient. US is the only imaging technique which can be used in field settings to assess CE prevalence because it can be run even on solar power or a small generator in remote field locations. Thanks to US classifications, the concept of stage-specific treatments was introduced and because US is repeatable, the scientific community has gained a clearer understanding of the natural history of the disease. This paper reviews the scope of US in CE, describes its strengths and weaknesses compared to other imaging techniques and its relationship with serodiagnosis and discusses sonographic features that may be helpful in differential diagnosis.
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Affiliation(s)
- Enrico Brunetti
- San Matteo Hospital Foundation, University of Pavia, Unit of Infectious and Tropical Diseases, Pavia, Italy
| | - Francesca Tamarozzi
- Center for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Carlo Filice
- San Matteo Hospital Foundation, University of Pavia, Unit of Infectious and Tropical Diseases, Pavia, Italy
| | - Markus Schindler Piontek
- Caritas Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Medical Clinic 2, Bad Mergentheim, Germany
| | | | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| | - Nathan Atkinson
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Department of Gastroenterology, Oxford, New Zealand
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany
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Bakdik S, Arslan S, Oncu F, Tolu I, Eryilmaz MA. Percutaneous treatment of hepatic cystic echinococcosis: the success of alcohol as a single endocavitary agent in PAIR, catheterization, and modified catheterization techniques. Radiol Med 2017; 123:153-160. [PMID: 29030721 DOI: 10.1007/s11547-017-0820-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This retrospective study aims at demonstrating the success rate, effectiveness, and advantages of alcohol as a scolicidal and sclerosing agent for the percutaneous treatment of liver hydatid cysts. METHODS A total of 554 liver hydatid cysts obtained from 347 patients admitted between January 2008 and February 2016 were retrospectively investigated. Of these, 435 (78.5%), 91 (16.4%), and 28 (5%) were classified as Gharbi type 1, 2, and 3, respectively. Type 1 and 2 cysts were treated using PAIR (puncture, aspiration, injection, respiration) and single puncture catheterization methods; type 3 lesions were treated using a modified catheterization technique. Alcohol was used as a scolicidal and sclerosing agent in all procedures. RESULTS After excluding three lesions (0.5%) because of lack of parenchymal support during catheterization, 274 (49.7%), 250 (45.3%), and 27 (4.9%) of 551 lesions were treated with PAIR, single puncture catheterization, and modified catheterization techniques, respectively. Therefore, a 99.5% of technical success rate was obtained. Major complications in 2 patients (0.5%) and minor complications were observed in 36 patients (10.3%). Mean hospital stay was 1.55±2.3 days (range: 0-23 days). Patients were followed-up for mean 19.6 months (range: 6-83 months), during which recurrences were detected in 19 patients (5.4%). CONCLUSIONS The use of alcohol as a scolicidal and sclerosing agent during the percutaneous treatment of liver hydatid cysts is associated with a high success rate and low rates of recurrence and complications, and should be considered an important alternative to surgical procedures.
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Affiliation(s)
- Suleyman Bakdik
- Department of Radiology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Serdar Arslan
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey.
| | - Fatih Oncu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Ismet Tolu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Mehmet Ali Eryilmaz
- Department of General Surgery, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
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Firpo G, Vola A, Lissandrin R, Tamarozzi F, Brunetti E. Preliminary Evaluation of Percutaneous Treatment of Echinococcal Cysts without Injection of Scolicidal Agent. Am J Trop Med Hyg 2017; 97:1818-1826. [PMID: 29016329 DOI: 10.4269/ajtmh.17-0468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Puncture, Aspiration, Injection of scolicidal agent, Re-aspiration is the most widely used percutaneous treatment of cystic echinococcosis (CE). Among its perceived risks is chemical sclerosing cholangitis, a serious complication due to the caustic effect of the scolicidal solution on the biliary tree, when a patent cystobiliary fistula occurs. To simplify the protocol, we decided to omit injection and reaspiration of the scolicidal agent and to implement a full course of albendazole (ABZ) therapy instead of the routine 1-month ABZ prophylaxis. We searched our databases for patients with CL (Cystic Lesion, suspected for CE), CE1, and CE3a cysts treated between October 2007 and January 2017 with percutaneous aspiration followed by at least 1 month of oral ABZ and with an ultrasound follow-up of at least 6 months. Fifteen patients matched our inclusion criteria. Follow-up ranged from 7 to 75 months. The oral ABZ course after the aspiration procedure ranged from 1 to 18 months. Eleven subjects (73.3%) had undergone a course of ABZ before the percutaneous procedure (min 15 days, max 16 months). Ten cysts (62.5%) had reached solidification (stage CE4) in 3 to 69 months. Four other cysts (26.7%) remained stable in stage CE3a, whereas two cysts (13.3%) reactivated to stage CE3b. Procedural perioperative complications occurred in 13.3% of patients, whereas complications during the follow-up occurred in 20% of patients. These proof-of-concept preliminary results are overall comparable with those reported in the literature for other percutaneous treatments, both in terms of response rate, relapse rate, and morbidity.
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Affiliation(s)
- Giovanni Firpo
- WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Ambra Vola
- Division of Infectious Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy.,WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Raffaella Lissandrin
- Division of Infectious Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy.,WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,Division of Infectious Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy.,WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Pavia, Italy
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Kahriman G, Ozcan N, Dogan S, Karaborklu O. Percutaneous treatment of liver hydatid cysts in 190 patients: a retrospective study. Acta Radiol 2017; 58:676-684. [PMID: 27565632 DOI: 10.1177/0284185116664226] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Hydatid liver disease (HLD) is a significant health problem, especially in endemic areas worldwide. Percutaneous treatment is an effective alternative therapeutic option. Purpose To present the clinical and radiological results of percutaneous treatment of HLD in 190 patients. Material and Methods Percutaneous treatment of HLD between April 2005 and March 2015 was analyzed retrospectively. The demographic data, numbers and types of cysts, initial and final volumes of the cysts, types of percutaneous treatment, and procedure-related complications were determined. Results A total of 190 patients (95 male patients and 95 female patients; age range, 5-82 years) with 283 liver hydatid cysts who underwent percutaneous treatment were included in the study. Of the 283 cysts, 234 (83%) were cystic echinococcosis CE1, 31 (11%) were CE3a, and 18 (6%) were CE2 cysts, according to the World Health Organization (WHO) classification. The percutaneous procedure was successful in all patients. A total of 12 (6.3%) major complications, including anaphylaxis, allergic skin reaction, perihepatic hemorrhage, and cavity infection, were seen. No mortality was noted. Recurrence in one patient and an additional cyst in one patient were seen. All patients were asymptomatic during the follow-up period. Mean volume reduction was 77.5%, with a mean follow-up period of 18 months. Conclusion Percutaneous treatment is an effective and safe method for the treatment of HLD. It should be regarded as a first-line treatment method for uncomplicated hydatid cysts.
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Affiliation(s)
- Guven Kahriman
- Department of Radiology, University of Erciyes, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Nevzat Ozcan
- Department of Radiology, University of Erciyes, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Serap Dogan
- Department of Radiology, University of Erciyes, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Oguz Karaborklu
- Department of Radiology, University of Erciyes, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
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Comparison of Long-Term Results of Percutaneous Treatment Techniques for Hepatic Cystic Echinococcosis Types 2 and 3b. AJR Am J Roentgenol 2017; 208:878-884. [PMID: 28199132 DOI: 10.2214/ajr.16.16131] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the long-term results of a modified catheterization technique for percutaneous treatment of hepatic cystic echinococcosis (CE) types 2 and 3b and to retrospectively compare the results of puncture, aspiration, injection, and reaspiration (PAIR); standard catheterization; and the modified catheterization technique. MATERIALS AND METHODS Seventy-three patients (37 male, 36 female; 75 cysts) with CE types 2 and 3b who underwent percutaneous treatment from March 1991 to August 2008 were included. Informed consent from all patients and approval of the ethics board were obtained. Patients were 6-79 years old. Twenty-three cysts (30.6%) were treated with PAIR, 26 (34.7%) with standard catheterization, and 26 (34.7%) with the modified catheterization technique. The results of the three techniques were statistically compared. RESULTS Among all patients, the cysts decreased in volume by 61.1% (range, 5-100%). Cysts recurred in 11 (47.8%) patients treated with PAIR, three (11.5%) treated with standard catheterization, and one (3.8%) treated with the modified catheterization technique. The recurrence rate was not significantly different between standard catheterization and the modified catheterization technique (p > 0.05), whereas significantly more recurrences developed after PAIR than with the other two techniques (p < 0.05). Twelve (16.4%) major and 16 (21.9%) minor complications developed. Significantly fewer major complications occurred with PAIR than with the modified catheterization technique, but the difference between standard catheterization and the other two techniques was not significant. CONCLUSION Treatment of CE types 2 and 3b with the modified catheterization technique was associated with a recurrence rate lower than what is seen with other techniques, and therefore it appears to be a safe, reliable, and efficient alternative.
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Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8:1169-1181. [PMID: 27729953 PMCID: PMC5055586 DOI: 10.4254/wjh.v8.i28.1169] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Echinococcus granulosus (E. granulosus) and Echinococcus multilocularis (E. multilocularis) infections are the most common parasitic diseases that affect the liver. The disease course is typically slow and the patients tend to remain asymptomatic for many years. Often the diagnosis is incidental. Right upper quadrant abdominal pain, hepatitis, cholangitis, and anaphylaxis due to dissemination of the cyst are the main presenting symptoms. Ultrasonography is important in diagnosis. The World Health Organization classification, based on ultrasonographic findings, is used for staging of the disease and treatment selection. In addition to the imaging methods, immunological investigations are used to support the diagnosis. The available treatment options for E. granulosus infection include open surgery, percutaneous interventions, and pharmacotherapy. Aggressive surgery is the first-choice treatment for E. multilocularis infection, while pharmacotherapy is used as an adjunct to surgery. Due to a paucity of clinical studies, empirical evidence on the treatment of E. granulosus and E. multilocularis infections is largely lacking; there are no prominent and widely accepted clinical algorithms yet. In this article, we review the diagnosis and treatment of E. granulosus and E. multilocularis infections in the light of recent evidence.
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Ramia JM, Del Cerro J, de la Plaza R, Adel F, García-Parreño J. [PAIR for complex hepatic hydatid disease]. Cir Esp 2015; 93:e45-7. [PMID: 23969076 DOI: 10.1016/j.ciresp.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/08/2013] [Indexed: 02/07/2023]
Affiliation(s)
- José Manuel Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Julián Del Cerro
- Unidad de Radiología Vascular e Intervencionista, Servicio de Radiología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Roberto de la Plaza
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Farah Adel
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Jorge García-Parreño
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
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Hepatic cystic echinococcosis: percutaneous treatment as an outpatient procedure. ASIAN PAC J TROP MED 2014; 7:212-5. [PMID: 24507642 DOI: 10.1016/s1995-7645(14)60023-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/15/2013] [Accepted: 12/15/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To demonstrate utility and safety of the puncture aspiration injection and reaspiration (PAIR) technique for outpatients. METHODS Percutaneous treatment with US guidance was applied to 33 patients for 44 cysts. Patients treated with the PAIR technique, were outpatients. PAIR and catheterization technique were evaluated for efficacy and safety of procedure and complication rates. RESULTS Thirty-five of 44 cysts were treated with the PAIR and 9 of 44 were treated with the catheterization technique. The success rate of the cysts Gharbi type 1 (CE1) and type 2 (CE3a) treated with the PAIR technique was 100%. In the follow up of 9 cysts treated with the catheterization technique, 2 of them (22%) developed cyst infection and 1 (11%) developed a biliary fistula. CONCLUSIONS The PAIR technique was found to be an effective and safe approach in order to treat Gharbi type 1 and type 2 cysts percutaneously for outpatients. It has a very low complication rate in comparison with the catheterization technique. So every effort should be made to finish the treatment with PAIR technique.
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Rinaldi F, Brunetti E, Neumayr A, Maestri M, Goblirsch S, Tamarozzi F. Cystic echinococcosis of the liver: A primer for hepatologists. World J Hepatol 2014; 6:293-305. [PMID: 24868323 PMCID: PMC4033287 DOI: 10.4254/wjh.v6.i5.293] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/22/2014] [Accepted: 03/18/2014] [Indexed: 02/06/2023] Open
Abstract
Cystic echinococcosis (CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptomatic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the ”watch and wait” approach for inactive cysts. Allocation of patients to these treatments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosis and the currently available evidence for clinical decision-making in cystic echinococcosis of the liver.
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Tuxun T, Zhang JH, Zhao JM, Tai QW, Abudurexti M, Ma HZ, Wen H. World review of laparoscopic treatment of liver cystic echinococcosis--914 patients. Int J Infect Dis 2014; 24:43-50. [PMID: 24747089 DOI: 10.1016/j.ijid.2014.01.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/26/2013] [Accepted: 01/12/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to provide a review of the world literature on the laparoscopic treatment of liver hydatid cyst. METHODS We conducted a literature search using PubMed, screening all English language publications on the laparoscopic treatment of liver hydatid cysts. Operative characteristics, perioperative morbidity, and clinical outcomes were tabulated. RESULTS A total of 57 published articles including 914 patients with 1116 hydatid cysts were identified. Of the resections done in the 914 patients, 89.17% were performed totally laparoscopically and 5.58% were gasless. The most common procedure was cystectomy (60.39%), followed by partial pericystectomy (14.77%) and pericystectomy (8.21%); the rest were segmentectomies. Conversion to open laparotomy occurred in 4.92% of reported cases (45/914). The common cause of conversion was anatomical limitations/inaccessible locations (16/45). The overall mortality was 0.22% (2/914 patients) and morbidity was 15.07%, with no intraoperative deaths reported. The most common complication was bile leakage (57/914). The postoperative recurrence was 1.09% (10/914 patients). CONCLUSIONS The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.
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Affiliation(s)
- Tuerhongjiang Tuxun
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Jin-Hui Zhang
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Jin-Ming Zhao
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Qin-Wen Tai
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Mierxiati Abudurexti
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Hai-Zhang Ma
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China
| | - Hao Wen
- Liver and Laparoscopic Surgery Department, Digestive and Vascular Surgery Center, 1st Affiliated Hospital of Xinjiang Medical University, No.137, Liyushan Road, Xinshi District, Urumqi, 830054, China.
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A Pseudo-Outbreak of Echinococcosis in Wisconsin. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e318279ee39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Singh AK, Shankar S, Gervais DA, Hahn PF, Mueller PR. Image-guided percutaneous splenic interventions. Radiographics 2012; 32:523-34. [PMID: 22411947 DOI: 10.1148/rg.322115135] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.
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Affiliation(s)
- Ajay K Singh
- Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
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Corona M, Cannavale A, Bruni A, Boatta E, Allegritti M, Lucatelli P, Fanelli F, Pucci A, Paciotti C, Salvatori FM. Case report: Percutaneous treatment of multiple honeycomb-like liver hydatid cysts (type III CE2, according to WHO classification). Indian J Radiol Imaging 2012; 22:23-6. [PMID: 22623811 PMCID: PMC3354352 DOI: 10.4103/0971-3026.95399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Percutaneous treatment has been developing as a reliable and effective alternative to surgery in the treatment of liver hydatid cysts. However, percutaneous treatment is strongly recommended only for some types of hydatid cysts (types I and II). We report a patient with type III (CE2, according to the WHO classification) multiple liver hydatid cysts treated with the PAIR (puncture-aspiration-injection-reaspiration) technique. The patient developed a secondary biliary fistula, which ultimately healed.
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Affiliation(s)
- Mario Corona
- Department of Radiology, Vascular and Interventional Radiology Unit, "Sapienza" University of Rome, Rome, Italy
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Diagnosis and management of hydatid liver disease in children: a report of 156 patients with hydatid disease. J Pediatr Surg 2012; 47:528-34. [PMID: 22424349 DOI: 10.1016/j.jpedsurg.2011.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 11/05/2011] [Accepted: 11/09/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND/PURPOSE There are many published reviews on adult hydatid disease and a guideline published by World Health Organization Informal Working Group (WHO-IWGE) in 2010. However, there are very few reports on hydatid liver disease in children with limited numbers of patients, and no comments were offered on childhood hydatid liver disease in the WHO-IWGE 2010 guideline. The aim of this study is to present our 17-year experience with 156 pediatric patients with hydatid liver disease and provide a treatment algorithm for children. METHODS The clinical records of 156 children with hydatid liver disease treated from January 1994 to January 2011 were retrospectively reviewed. Patient sex, age at diagnosis, symptoms, disease location, cyst numbers and sizes, treatment choices, medical treatment duration, surgical methods, and complications were recorded. Treatment of liver hydatidosis included 3 different schedules: (1) small (<5 cm) liver cysts treated with albendazole (ABZ) only, (2) cysts (>5 cm) located at the liver surface treated with surgery combined with ABZ, and (3) all (>5 cm) liver cysts embedded deep in the liver parenchyme treated with percutaneous drainage and ABZ. Albendazole was given (10 mg/kg twice a day) and continued for 6 months after initial therapy. RESULTS There were 92 boys and 64 girls with an average age of 9.2 years (range, 1.1-15 years). A total of 376 cysts were detected in 156 patients. The follow-up period ranged from 1 to 10 years (median, 6.5 years). Complications were classified according to the Dindo classification. After the first 6 months of therapy, grade I complications occurred in 12.1% of patients, grade II complications in 7.4%, and grade IIIb complications in 7.3%. There were no grade IIIa, IVa, or IVb complications. At 1 year, grade II complications were recorded in 9.6% of 15 patients, and grade IIIb complications, in 1.2% of patients. During the 17 years reviewed, there were no mortalities (0% grade V complications). CONCLUSIONS Based on this experience, we believe that suitable treatment should be chosen based on factors such as cyst number, cyst location (on the surface or deep in the organ), proximity to vascular structures, whether the cyst is complicated, and additional organ involvement or not. In addition, although the results of our study mostly agree with the results in the WHO-IWGE 2010 report, there are some noticeable differences between these 2 studies. Hence, we believe that the WHO-IWGE 2010 recommendations should be updated by incorporating the childhood observations.
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Oral A, Yigiter M, Demirci E, Yildirim ZK, Kantarci M, Salman AB. A case of undifferentiated embryonic liver sarcoma mimicking cystic hydatid disease in an endemic region of the world. J Pediatr Surg 2011; 46:e5-9. [PMID: 22075370 DOI: 10.1016/j.jpedsurg.2011.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 07/04/2011] [Accepted: 07/06/2011] [Indexed: 11/17/2022]
Abstract
Undifferentiated embryonic liver sarcoma (UELS) is a rare highly malignant neoplasm that predominantly occurs in children between 5 and 10 years of age. The typical radiologic appearance on ultrasound and computed tomography of UELS shows a large septated mass having combined cystic and solid components. These radiographic features, however, are not specific to UELS and are shared by other more common and benign diseases of the liver. For example, cystic hydatid disease (CHD), caused by larvae of the Echinococcus tapeworm, is the most common indication for hepatic operations in children residing in endemic regions of the world. Undifferentiated embryonic liver sarcoma and CHD are 2 diseases that share overlapping presenting features of patient age, symptoms, and radiologic appearance. Surgeons who operate in Echinococcal endemic regions must be aware that not all hepatic cystic masses are necessarily CHD and may be other more rare malignant diseases such as UELS.
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Affiliation(s)
- Akgun Oral
- Department of Pediatric Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
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Sweetser S, Loftus CG. Massive hepatic echinococcosis. Hepatology 2011; 53:1771-2. [PMID: 21520183 DOI: 10.1002/hep.24139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Seth Sweetser
- Mayo Clinic College of Medicine, Rochester, MN, USA.
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Laparoscopic drainage of a hepatic echinococcal cyst: a case report. Case Rep Gastrointest Med 2011; 2011:107087. [PMID: 22606413 PMCID: PMC3350300 DOI: 10.1155/2011/107087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 06/26/2011] [Indexed: 12/28/2022] Open
Abstract
The Echinococcus granulosus tapeworm causes hepatic echinococcosis. It is endemic in the Mediterranean region, Middle East, and South America. Human infection is secondary to accidental consumption of ova in feces. Absorption through the bowel wall and entrance into the portal circulation leads to liver infection. This case involves a 34 y/o Moroccan male with an echinococcal liver cyst. His chief complaint was RUQ pain. The patient was treated with albendazole and praziquantel. His PMH and PSH was noncontributory. Patient was not on any other medications. ROS was otherwise unremarkable. The patient was AF VSS. He was tender to palpation in RUQ. Liver function tests were normal. Echinococcal titers were positive. CT demonstrated a large cystic lesion in the right lobe of the liver measuring 13.5 cm in diameter. The patient underwent successful laparoscopic drainage and excision of echinococcal cyst. Final pathology demonstrated degenerating parasites (E. granulosus) of echinococcal cyst.
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Abstract
PURPOSE OF REVIEW Cystic echinococcosis, or cystic hydatidosis, is a complex, chronic disease with a cosmopolitan distribution. In humans, its clinical spectrum ranges from asymptomatic infection to severe, rarely even fatal disease. Four approaches in clinical management exist: surgery, percutaneous techniques and drug treatment for active cysts, and the so-called watch and wait approach for inactive cysts. Allocation of patients to these treatments should be based on cyst stage, size and location, available clinical expertise and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated.We review the currently available evidence for clinical decision-making and discuss ways to improve standards of care of one of the most neglected infectious diseases. RECENT FINDINGS Data are mostly derived from case series and small clinical trials, and treatment guidelines remain at the level of expert opinion. No single high-quality comparative clinical trial of the four treatment options is available to resolve important questions such as stage-specific allocation of treatments, adverse events and long-term relapse rates. Recent work is beginning to acknowledge this problem. SUMMARY Currently, four treatment modalities are available for cystic echinococcosis. The level of evidence on which clinicians have to rely is low. For the time being patients should thus be treated in referral centres. Proper comparative clinical trials are urgently needed.
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Giorgio A, de Stefano G, Di Sarno A, Liorre G, Scognamiglio U, Iaquinta S, Mariniello A, Giorgio V, de Stefano M, Perrotta A. Clinical and sonographic management of viable hydatid liver cysts. J Ultrasound 2008; 11:107-12. [PMID: 23396755 DOI: 10.1016/j.jus.2008.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM The aim of this study was to review our 18-year experience in the treatment of viable hydatid liver cysts (HLCs) with double percutaneous aspiration and ethanol injection (D-PAI) and to provide indications for the clinical management of HLCs. MATERIALS AND METHODS From January 1989 to December 2007, 127 patients (100 males; 13-80 years) with 184 viable HLCs (137 univesicular, 47 multivesicular; 2.8-20 cm) underwent D-PAI. RESULTS Ultrasonography (US) showed complete disappearance of 125/184 (68%) cysts; in the remaining 59 cases, an inactive solid (37 cases, 20%) or liquid pattern (22 cases, 12%) was observed with volume decreases of 50-80%. The final US pattern was unmodified during the follow-up in 96.8%. Local recurrences were observed in 5 patients (3.9%): 4 patients with 8 multivesicular cysts and 1 patient with a bilocular cyst (with a solid pattern on US) that ruptured into the biliary tree 2 years after the procedure and disappeared after endoscopic sphincterectomy. The mortality rate was 0.8%, and the overall morbidity was 8.6%. The mean hospital stay was 2.9 days. The time of healing for smaller cysts (<5 cm) was shorter than that of large cysts (≥5 cm) (P < 0.001). CONCLUSION Our long-term results confirm the high effectiveness of D-PAI in the treatment of HLCs. These results suggest that multilocular cysts require closer follow-up than unilocular cysts.
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Affiliation(s)
- A Giorgio
- Infectious Diseases and Interventional Ultrasound Unit, D. Cotugno Hospital, Naples, Italy
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