Efficacy and Safety of PAIR for Cystic Echinococcosis: Experience on a Large Series of Patients from Bulgaria

Golemanov, Branimir; Grigorov, N; Mitova, R.; Genov, Jordan; Vuchev, Dimitar; Tamarozzi, Francesca; Brunetti, Enrico

doi:10.4269/ajtmh.2011.10-0312

Cited by 51 publications

(49 citation statements)

References 12 publications

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“…Moreover, over 7% of PAIR procedures were performed on multivesiculated CE2 and CE3b cysts, which have a high rate of relapses after classic PAIR. 9 Of all cysts treated with ABZ, over 21% were multivesiculated CE2 and CE3b cysts, which are highly prone to relapse after ABZ, 10,11 and 13.5% were inactive CE4 and CE5 cysts (Table 3). In fact, PAIR and ABZ alone were the treatment modalities mostly used for CE3b cysts (33.3% and 44.4%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Hepatic Cystic Echinococcosis in Patients from the Southeastern Rhodope Region of Bulgaria in 2004–2013: Comparison of Current Practices with Expert Recommendations

Muhtarov¹,

Rainova²,

Tamarozzi³

2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Cystic echinococcosis (CE) is a clinically complex chronic parasitic disease, management options for which include surgery, percutaneous treatments, and treatment with albendazole (ABZ) for active cysts, and the "Watch-andWait" approach for uncomplicated, inactive cysts. We examined, retrospectively, the clinical management of 334 patients with hepatic CE from the southeastern Rhodope region of Bulgaria between 2004 and 2013. Cysts were reclassified according to the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) on the basis of ultrasound reports and images. The majority (62.3%) of uncomplicated cysts were CE1, 66% of which were treated surgically. Of all interventions, 5% were performed on inactive uncomplicated CE4-CE5 cysts. About half (47.6%) of these cysts were therefore treated inappropriately, exposing patients to unnecessary treatment-related risks and the health system to unnecessary costs. No management change was observed after the publication of the WHO-IWGE Expert Consensus recommendations in 2010. In Bulgaria, ABZ is still used in interrupted cycles as this is reimbursed, and peri-interventional chemoprophylaxis was not administered in the majority of surgical patients. Efforts are needed to introduce the WHO-IWGE classification and management recommendations and to encourage reception of state-of-the-art practices by public health regulatory bodies to improve patient quality of care and optimization of health resources.

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Section: Discussionmentioning

confidence: 99%

Treatment of Hepatic Cystic Echinococcosis in Patients from the Southeastern Rhodope Region of Bulgaria in 2004–2013: Comparison of Current Practices with Expert Recommendations

Muhtarov¹,

Rainova²,

Tamarozzi³

2016

The American Society of Tropical Medicine and Hygiene

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“…Out of the 19 cysts surgically removed, 13 were classified as CE3b, a stage known to be poorly responsive to other types of treatment. 8,9 Demographic and clinical information for the 14 study patients is summarized in Table 1. Information regarding treatment duration and medical personnel used per case is summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, Italy

Narra

Maestri

Budke

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from 5,874 to 23,077 (median 11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach.

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“…Golemanov et al reported that 8.9% of patients who presented with hydatid cysts of ≥10 cm in diameter developed fistulization when treated a second time by the PAIR method (8).…”

Section: Discussionmentioning

confidence: 99%

Rare But Life-Threatening Complication of Hydatid Disease

Karakaya

Kalkan²,

Karakaya³

et al. 2017

TurkiyeParazitolDerg

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Cystic echinococcosis is an infectious disease that is potentially associated with the biliary tract. Of thousand cases of hydatid cysts that were successfully treated by the Örmeci method, only two presented with cholangitis subsequent to the percutaneous treatment. These cases were treated with endoscopic retrograde cholangiopancreatography, and this study provides details regarding the clear fistulization of hydatid cysts into the biliary tract.

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Efficacy and Safety of PAIR for Cystic Echinococcosis: Experience on a Large Series of Patients from Bulgaria

Cited by 51 publications

References 12 publications

Treatment of Hepatic Cystic Echinococcosis in Patients from the Southeastern Rhodope Region of Bulgaria in 2004–2013: Comparison of Current Practices with Expert Recommendations

Treatment of Hepatic Cystic Echinococcosis in Patients from the Southeastern Rhodope Region of Bulgaria in 2004–2013: Comparison of Current Practices with Expert Recommendations

Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, Italy

Rare But Life-Threatening Complication of Hydatid Disease

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