Percutaneous Aspiration-Injection-Reaspiration Drainage Plus Albendazole or Mebendazole for Hepatic Cystic Echinococcosis: A Meta-analysis

Abstract

Using meta-analysis methodology, we compared the clinical outcomes for 769 patients with hepatic cystic echinococcosis treated with percutaneous aspiration-injection-reaspiration (PAIR) plus albendazole or mebendazole (group 1) with 952 era-matched historical control subjects undergoing surgical intervention (group 2). The rate of clinical and parasitologic cure (P<.0001) was greater in patients receiving PAIR plus chemotherapy. Disease recurrence (P<.0001), major complications (anaphylaxis, biliary fistula, cyst infection, liver/intra-abdominal abscess, and sepsis; P<.0001), minor complications (P<.0001), and death (P<.0824) occurred more frequently among surgical control subjects. Fever (P<.002) and minor allergic reactions subjects (P<.0001) were more common among PAIR-treated subjects. The mean durations of hospital stay were 2.4 days for group 1 and 15.0 days for group 2 (P<.001). Compared with surgery, PAIR plus chemotherapy is associated with greater clinical and parasitologic efficacy; lower rates of morbidity, mortality, and disease recurrence; and shorter hospital stays.

A comparison of imaging guided double percutaneous aspiration injection and surgery in the treatment of cystic echinococcosis of liver

“…Our results, however, are consistent with other reports of PT. 17,22,[31][32][33][34] In our study, both the groups showed a pattern of rise in titres on IgG ELISA 1 month after the intervention, followed by a gradual fall to baseline values. The rise in titres after either intervention reflects an increase in IgG antibody that occurs owing to small amounts of echinococcal antigens gaining access to the blood stream during the procedure.…”

“…[19][20][21] A meta-analysis of multiple studies on treatment of CE showed a cure rate of 89.8% for patients undergoing surgery. 22 Considering a 10% difference in cure rates to be clinically important, 44 patients are required to be 90% sure that the upper limit of a one-sided 95% confidence interval (CI) (or equivalently a 90% two-sided CI) will exclude a difference in favour of the standard group of .10%. A sample size of 44 patients was therefore selected.…”

“…In the absence of any guidelines for assessment of treatment response, definitions adapted from Smego et al 22 were used to categorize response to treatment. Successful treatment was defined as disappearance of clinical symptoms with separation of the endocyst from the pericyst and a decrease in cyst size up to 50% or less, forming either a small residual cyst cavity or a pseudotumour or no residual lesion.…”

Primary paraspinal hydatid cyst treated with puncture, aspiration, injection and re-aspiration (PAIR) technique: a case report

“…This technique was first developed by Mueller et al as an alternative treatment method against surgical excision of the liver hydatid cysts [7]. Although, puncture of a hydatid cyst has long been discouraged because of potential complications, such as anaphylactic shock or risk of iatrogenic spreading, there is an expanding literature suggesting that PAIR is effective for treatment of primary uncomplicated hepatic cysts [13]. However, this technique has been used for solid organ hydatid cysts.…”

“…Currently, first treatment choice of muscular hydatid cyst is the combination of en bloc resection and albendazole chemotherapy [2]. On the other hand, puncture, aspiration, injection of scolicidal agent and reaspiration (PAIR) is a non-operative technique which is now widely used for the treatment of liver hydatid cyst [13]. We report a case of primary hydatid cyst seated in erector spinae muscle which was treated successfully with PAIR technique.…”