P.A.I.R. in Cystic Echinococcosis : technique, indications, results

The percutaneous treatment of liver CE (hydatid cysts) were considered to be contraindicated due to two main potential risks: anaphylactic shock and abdominal dissemination of the disease.

Since the first case percutaneously treated was published, several series of successful percutaneous treatment of the liver and the other abdominal organs such as kidneys, peritoneum, spleen, soft tissue and orbital cavity CE cysts have appeared in the literature. The main indication for percutaneous treatment of hydatid cyst includes “viable cysts”.

Different types according to Gharbi or WHO classifications are treated by different percutaneous techniques.

According to WHO classification, CE 1 and 3a are considered to be most appropriate for PAIR or Standart Catheterization technique; CE 2 and CE 3b Modified catheterization technique (MoCaT).

No treatment is necessary in patients with CE 4 and 5 which are managed by “Wait and Watch approach”. Although surgery is a traditional method of treatment, the indication for surgery is now limited by the hydatid cysts ruptured into biliary system, pleura or peritoneum.

Considering the number of percutaneously treated patients, it is reasonable to conclude that the mortality rate is about 0.047%.

Dissemination after percutaneous treatment of the liver hydatid disease was never reported in any of the published series.

Other major complications need to be addressed are superinfection of the cavity, cystobiliary communication and severe anaphylactic reaction which are reported overall rate of about 10%. Minor complications such as urticaria, severe itching and hypotension can easily be treated with antihistaminic. In some patients, fever, not exceeding 38.5ºC, may also be observed and generally does not necessitate any medication. Recurrence rate varies among 0-4%. Recurrent cysts are also managed by percutaneous approach.

Considering the overall data in the literature regarding hospital stay is about 2.5-4.2 days. Percutaneous treatment of liver CE is an effective and safe procedure with its unique advantages such as shorter hospital stay, low complication rate, low mortality and recurrence rates.

Today, the percutaneous approach has an important role in treatment of hydatid cysts not only in the liver but also in the other organs and tissue. Therefore, it must be first treatment option whenever it is indicated.