Echinococcosis surgery: Difference between revisions
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{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}} | {{CMG}} '''Associate Editor-In-Chief:''' {{CZ}} | ||
==Overview== | ==Overview== | ||
Surgery for echinococcosis is indicated if the cyst is non-echoic and greater than 5 cm in diameter (CE1m and l), contains daughter cysts (CE2), and/or is associated with the detachment of membranes (CE3), consists of multiple cysts that are accessible to be punctured, are infected or in the patients who fail to respond to [[chemotherapy]] alone. Puncture, | Surgery for [[echinococcosis]] is indicated if the cyst is non-echoic and greater than 5 cm in diameter (CE1m and l), contains daughter cysts (CE2), and/or is associated with the detachment of membranes (CE3), consists of multiple cysts that are accessible to be punctured, are [[infected]] or in the patients who fail to respond to [[chemotherapy]] alone. Puncture, aspiration, [[injection]] and reaspiration, also known as the PAIR protocol, is utilized for the surgical treatment of [[Echinococcal cyst|echinococcal cysts]]. | ||
==Surgery== | ==Surgery== | ||
===Indications for PAIR=== | ===Indications for PAIR=== | ||
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* Cysts with daughter [[cysts]] (CE2), and/or with detachment of membranes (CE3) | * Cysts with daughter [[cysts]] (CE2), and/or with detachment of membranes (CE3) | ||
* Multiple [[cysts]] if accessible to puncture | * Multiple [[cysts]] if accessible to puncture | ||
* Infected [[cysts]] | * [[Infected]] [[cysts]] | ||
* Patients who fail to respond to [[chemotherapy]] alone | * Patients who fail to respond to [[chemotherapy]] alone | ||
| Line 19: | Line 19: | ||
!Preferred management | !Preferred management | ||
|- | |- | ||
|Prophylaxis pre- & post procedure | |[[Prophylaxis]] pre- & post procedure | ||
|[[Albendazole]] | |[[Albendazole]] | ||
* To be administered 24 to 4 hours before intervention and 15 days to 30 days after intervention according to cyst size | * To be administered 24 to 4 hours before intervention and 15 days to 30 days after intervention according to [[cyst]] size | ||
* No treatment if pregnant | * No treatment if [[pregnant]] | ||
|- | |- | ||
|Communication with biliary tree | |Communication with [[biliary tree]] | ||
|[[ERCP]] + cystography or cystography alone | |[[ERCP]] + cystography or cystography alone | ||
|- | |- | ||
|Electrolytes in the fluid | |Electrolytes in the fluid | ||
|Not mandatory; may help for assessing the nature of the cyst | |Not mandatory; may help for assessing the nature of the [[cyst]] | ||
|- | |- | ||
|Scolicidal agent to be used | |Scolicidal agent to be used | ||
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|- | |- | ||
|Evaluation of viability | |Evaluation of viability | ||
|Microscopic examination | |Microscopic examination, staining with [[methylene blue]]/eosin red | ||
|- | |- | ||
|Needle vs catheter | |Needle vs catheter | ||
|Needle for cysts < 5 cm or in multiloculated cysts | |Needle for cysts < 5 cm or in multiloculated cysts, catheter for cyst > 5 cm (PAIRD) | ||
|- | |- | ||
|Follow-up | |Follow-up | ||
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|} | |} | ||
===Contraindications for PAIR=== | ===Contraindications for PAIR=== | ||
* Non-cooperative patients and inaccessible or risky location of the cyst in the liver | * Non-cooperative patients and inaccessible or risky location of the [[cyst]] in the [[liver]] | ||
* Cyst in spine, brain and/or heart | * [[Cyst]] in [[spine]], [[brain]] and/or [[heart]] | ||
* Inactive or calcified lesion | * Inactive or [[Calcification|calcified]] lesion | ||
* Cysts communicating with the biliary tree | * Cysts communicating with the [[biliary tree]] | ||
* Cysts open into the abdominal cavity, bronchi and urinary tract | * Cysts open into the [[abdominal cavity]], [[Bronchus|bronchi]] and [[urinary tract]] | ||
===Benefits of PAIR=== | ===Benefits of PAIR=== | ||
* Minimal invasiveness | * Minimal invasiveness | ||
* Reduced risk compared with surgery | * Reduced risk compared with surgery | ||
* Confirmation of diagnosis | * Confirmation of diagnosis | ||
* Removal of large numbers of protoscolices with the aspirated cyst fluid | * Removal of large numbers of protoscolices with the aspirated [[cyst]] [[fluid]] | ||
* Improved efficacy of chemotherapy given before and after puncture | * Improved efficacy of chemotherapy given before and after puncture | ||
* Reduced hospitalization time | * Reduced hospitalization time | ||
Revision as of 20:29, 24 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Surgery for echinococcosis is indicated if the cyst is non-echoic and greater than 5 cm in diameter (CE1m and l), contains daughter cysts (CE2), and/or is associated with the detachment of membranes (CE3), consists of multiple cysts that are accessible to be punctured, are infected or in the patients who fail to respond to chemotherapy alone. Puncture, aspiration, injection and reaspiration, also known as the PAIR protocol, is utilized for the surgical treatment of echinococcal cysts.
Surgery
Indications for PAIR
Patients with:
- Non-echoic lesion ≥ 5 cm in diameter (CE1m and l)
- Cysts with daughter cysts (CE2), and/or with detachment of membranes (CE3)
- Multiple cysts if accessible to puncture
- Infected cysts
- Patients who fail to respond to chemotherapy alone
PAIR Protocol
The critical points in the PAIR protocol can be summarized below[1][2][3][4]
| PAIR Protocol | Preferred management |
|---|---|
| Prophylaxis pre- & post procedure | Albendazole |
| Communication with biliary tree | ERCP + cystography or cystography alone |
| Electrolytes in the fluid | Not mandatory; may help for assessing the nature of the cyst |
| Scolicidal agent to be used | Hypertonic saline (at least 15 % final concentration in cyst) or 95 % alcohol |
| Quantity of scolicide injected | At least 1/3 of the aspirated quantity |
| Evaluation of viability | Microscopic examination, staining with methylene blue/eosin red |
| Needle vs catheter | Needle for cysts < 5 cm or in multiloculated cysts, catheter for cyst > 5 cm (PAIRD) |
| Follow-up | Every week for the 1st month, then every other month for the 1st year, then every year for 10 years |
Contraindications for PAIR
- Non-cooperative patients and inaccessible or risky location of the cyst in the liver
- Cyst in spine, brain and/or heart
- Inactive or calcified lesion
- Cysts communicating with the biliary tree
- Cysts open into the abdominal cavity, bronchi and urinary tract
Benefits of PAIR
- Minimal invasiveness
- Reduced risk compared with surgery
- Confirmation of diagnosis
- Removal of large numbers of protoscolices with the aspirated cyst fluid
- Improved efficacy of chemotherapy given before and after puncture
- Reduced hospitalization time
- Cost of the puncture and chemotherapy usually less than that of surgery or chemotherapy alone
References
- ↑ Rajesh R, Dalip DS, Anupam J, Jaisiram A (2013). "Effectiveness of puncture-aspiration-injection-reaspiration in the treatment of hepatic hydatid cysts". Iran J Radiol. 10 (2): 68–73. doi:10.5812/iranjradiol.7370. PMC 3767020. PMID 24046781.
- ↑ Gabal AM, Khawaja FI, Mohammad GA (2005). "Modified PAIR technique for percutaneous treatment of high-risk hydatid cysts". Cardiovasc Intervent Radiol. 28 (2): 200–8. doi:10.1007/s00270-004-0009-5. PMID 15883860.
- ↑ Nasseri Moghaddam S, Abrishami A, Malekzadeh R (2006). "Percutaneous needle aspiration, injection, and reaspiration with or without benzimidazole coverage for uncomplicated hepatic hydatid cysts". Cochrane Database Syst Rev (2): CD003623. doi:10.1002/14651858.CD003623.pub2. PMID 16625588.
- ↑ Etlik O, Arslan H, Bay A, Sakarya ME, Harman M, Temizoz O, Kayan M, Bakan V, Unal O (2004). "Abdominal hydatid disease: long-term results of percutaneous treatment". Acta Radiol. 45 (4): 383–9. PMID 15323389.