Medical treatment versus “Watch and Wait” in the clinical management of CE3b echinococcal cysts of the liver

Abstract

BackgroundAvailable treatments for uncomplicated hepatic cystic echinococcosis (CE) include surgery, medical therapy with albendazole (ABZ), percutaneous interventions and the watch-and-wait (WW) approach. Current guidelines indicate that patients with hepatic CE should be assigned to each option based on cyst stage and size, and patient characteristics. However, treatment indications for transitional CE3b cysts are still uncertain. These cysts are the least responsive to non-surgical treatment and often present as indolent, asymptomatic lesions that may not warrant surgery unless complicated. Evidence supporting indications for treatment of this stage is lacking. In the attempt to fill this gap before the implementation of randomized clinical trials, we compared the clinical behavior of single hepatic CE3b cysts in 60 patients followed at the WHO Collaborating Centre for Cystic Echinococcosis of the University of Pavia.MethodsWe analyzed retrospectively data of 60 patients with hepatic CE3b cysts seen at our clinic over 27 years, who either received ABZ or were monitored with WW. Univariate and multivariate analysis were performed to investigate the effect on outcome (inactivation or relapse) of variables such as age, sex, origin, treatment, cyst size and presence of other echinococcal hepatic cysts using a multiple failure Cox proportional hazard model.ResultsABZ treatment was positively associated with inactivation (p < 0.001), but this was not permanent, and no association was found between therapeutic approach and relapse (p = 0.091). No difference was found in the rate of complications between groups.ConclusionsIn conclusion, our study shows that ABZ treatment induces temporary inactivation of CE3b cysts, while during WW cysts remain stable over time. As the rate of adverse events during periods of ABZ treatment and WW did not differ significantly in the follow-up period considered in this study (median 43 months, IQR 10.7-141.5), expectant management might represent a valuable option for asymptomatic CE3b cysts when strict indication for surgery is absent and patients comply with regular long-term follow-up.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-492) contains supplementary material, which is available to authorized users.

Evaluation of Patients with Cystic Echinococcosis

“…Spleen (12) 77.7 (7) Splenectomy (6) Cystostomy and drainage (1) Bone (5) 100 (5) Debridement (3) Partial cystectomy and drainage (1) Mesentery (7) 85.1 (6) Small bowel resection (1) Cystectomy (5) Omentum (6) 100 (6) Cystectomy (6) Muscle (3) 100 (3) Cystectomy (3) Brain (2) 100 (2) Cystectomy (2) Adrenal (1) 100 (1) Cystectomy (1) Bladder (1) 100 (1) Cystectomy (1) Pancreas (1) 100 (1) Cystectomy (1) Turkiye Parazitol Derg 2017; 41: [28][29][30][31][32][33] Türkoğlu at al. Cystic Echinococcosis and lack of disease control programs (1,6,7).…”

The Italian registry of cystic echinococcosis (RIEC): the first prospective registry with a European future

“…However, comparison of notified cases with hospital records indicates a clear discrepancy, with consistent underestimation of the burden of CE [17,18] and imported cases and between new and re-admitted cases, and lack of collection of important epidemiological data such as occupation and other risk factors. Given the chronicity and frequent relapses in CE [24,25], patients often access different health centres over time, which could lead to potential duplication of data, which would also contribute to inaccurate statistics. In addition, aspects such as cyst stage and therapy outcome, which have a profound impact on the clinical management of patients and in turn on public health resource allocation, are generally not collected in notification forms.…”

Comparison of Larger Diameter and Multiple Cysts in the Treatment of Giant Hydatid Cysts of Liver

“…Significant complications are associated with giant HCs, such as the cyst's penetration into other organs, cholangitis and anaphylactic shock. High morbidity and mortality may result from these complications [2][3][4]6 .…”

“…A hydatid cyst (HC) is produced from hepatic hydatidosis, aparasitic disease caused by the cestoda Echinococcus granulosus (EG) [1][2][3] . HCs are mostly seen in the liver (70%) in humans 3,4 .…”