Document Detail


Diagnosis and treatment of hepatic echinococcosis: an overview.
MedLine Citation:
PMID:  15696850     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Surgery has long been considered the first-choice treatment in patients with echinococcosis of the liver. The poorly predictable outcome of older studies using mebendazole or albendazole confirmed this belief. Since the introduction of a percutaneous technique (PAIR; puncture, aspiration, injection, reaspiration) treatment policy is changing. The actual question is which treatment is preferred in which patients. METHODS: Review of recent literature. RESULTS: Laparoscopic treatment of anteriorly located hepatic cysts is a new surgical technique with high success rates (77%-100%) and low complication (0%-17%) and recurrence rates (0%-9%). Albendazole is superior to mebendazole treatment. Degenerative changes were found in 82% of patients treated with albendazole and in 56% of those treated with mebendazole. The main problem is the high relapse rate: 25% mostly within 2 years. PAIR proved to be superior to albendazole treatment (88% versus 18%) and equally effective as surgery (86% versus 76%). A combined injection of alcohol with polidocanol is a simple alternative to PAIR. Percutaneous evacuation of cyst content (PEVAC) made percutaneous treatment accessible to patients with complicated cysts. CONCLUSIONS: Albendazole is the first-choice treatment in patients with univesicular cysts. PAIR or combined injection of alcohol with polidocanol is indicated when pain is intractable or albendazole fails. In patients with multivesicular cysts, PEVAC is a better choice. Surgery is the first-choice treatment only when the expertise of percutaneous treatment is not available or when percutaneous treatment fails.
Authors:
H G Schipper; P A Kager
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Scandinavian journal of gastroenterology. Supplement     Volume:  -     ISSN:  0085-5928     ISO Abbreviation:  Scand. J. Gastroenterol. Suppl.     Publication Date:  2004  
Date Detail:
Created Date:  2005-02-08     Completed Date:  2005-05-05     Revised Date:  2008-02-13    
Medline Journal Info:
Nlm Unique ID:  0437034     Medline TA:  Scand J Gastroenterol Suppl     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  50-5     Citation Subset:  IM    
Affiliation:
Dept. of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, The Netherlands. h.g.schipper@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
Anthelmintics / therapeutic use
Echinococcosis, Hepatic / diagnosis*,  therapy*
Humans
Laparoscopy
Punctures
Suction
Chemical
Reg. No./Substance:
0/Anthelmintics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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