Safety of percutaneous drainage for liver hydatid cysts

Losanoff and associates1 expressed
their concern that the safety and
effectiveness of percutaneous therapy
(e.g., the PAIR [puncture, aspiration,
injection, reaspiration] technique) for
cystic echinococcosis has not been
fully established. We believe that extensive
experience in many countries
has found that when physicians use a
protocol that addresses the major
safety issues, such as anaphylactic
shock, sclerosing cholangitis and peritoneal
dissemination, the safety and
efficacy of this approach to treatment
is comparable or superior to conventional
surgical techniques.
Sclerosing cholangitis has been
described in the literature as a consequence
of surgery2 but rarely, if ever,
after PAIR. In our protocol,3 we inject
hypertonic contrast agent into
the cyst cavity after aspiration of the
fluid. This allows the detection of
communications with the biliary tree
that might have gone unnoticed at
the time of imaging because of intracystic
pressure. If communication is
detected, we do not inject alcohol,
but simply leave the contrast agent
inside. Being hypertonic, the agent is
scolicidal but produces no damage to
the biliary epithelium. Peritoneal dissemination
of inadvertently released
protoscolices is prevented by prophylactic
administration of albendazole
(as is routine postoperatively).
Although long-term (5–10 yr)
follow-up is needed to assess the rate
of postoperative recurrence or dissemination,
some reports have addressed
this aspect.4 Our findings
from patients followed up for more
than 10 years (unpublished data),
based on whole body CT scanning
performed on 5 patients show no
signs of dissemination or recurrence
in the peritoneum or at any other
site. As for serologic surveillance, we
do not believe that at the present
stage of development available tests
can be relied upon for follow-up.
Current research performed at our
centre is designed to evaluate
whether immunoglobulin E antibodies
or total and specific immunoglobulin
G subclasses can be used to
determine the outcome of treatment.