Percutaneous drainage and combined praziquantel-albendazole therapy: a novel approach for the treatment of simple echinococcal liver cysts.

Autor:	Richter J; Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany., Lindner AK; Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany., Geisel D; Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany., Fleckenstein FN; Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany., Torsello GF; Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany., Millet Pascual-Leone B; Department of Infectious Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany., Ivanov O; Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany., Zöllner C; Department of Gastroenterology and Hepatology, Charité Universitätsmedizin Berlin, Berlin, Germany., Wilde AB; Department of Gastroenterology and Hepatology, Charité Universitätsmedizin Berlin, Berlin, Germany., Equihua Martinez G; Institute of International Health, Charité Universitätsmedizin Berlin, Berlin, Germany.
Jazyk:	angličtina
Zdroj:	Zeitschrift fur Gastroenterologie [Z Gastroenterol] 2024 Apr; Vol. 62 (4), pp. 500-507. Date of Electronic Publication: 2023 Sep 20.
DOI:	10.1055/a-2084-3735
Abstrakt:	Cystic echinococcosis (CE) is a worldwide helminthic zoonosis causing serious disease in humans. The WHO Informal Working Group on Echinococcosis recommends a stage-specific treatment approach of hepatic CE that facilitates the decision on what therapy option is most appropriate. Percutaneous aspiration, instillation of a scolicide, e.g., ethanol or hypertonic saline, and subsequent re-aspiration (PAIR) have been advocated for treating medium-size unilocular WHO-stage CE1 cysts. PAIR can pose a risk of toxic cholangitis because of spillage of ethanol in the case of a cysto-biliary fistula or of life-threatening hypernatriaemia when hypertonic saline is used. The purpose of our study is to develop an alternative, safe, minimally invasive method to treat CE1 cysts, avoiding the use of toxic topic scolicides.We opt for percutaneous drainage (PD) in four patients: the intrahepatic drainage catheter is placed under CT-fluoroscopy, intracystic fluid is aspirated, and the viability of intracystic echinococcal protoscolices is assessed microscopically. Oral praziquantel (PZQ) is added to albendazole (ABZ) instead of using topical scolicidals.Protoscolices degenerate within 5 to 10 days after PZQ co-medication at a cumulative dosage of 250 to 335 mg/kg, and the cysts collapse. The cysts degenerate, and no sign of spillage nor relapse is observed in the follow-up time of up to 24 months post-intervention.In conclusion, PD combined with oral PZQ under ABZ coverage is preferable to PAIR in patients with unilocular echinococcal cysts. Competing Interests: The authors declare that they have no conflict of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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