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Correspondence

Correspondence

Enrico Brunetti, Carlo Filice and Peter Schantz
CAN J SURG October 01, 2002 45 (5) 388;
Enrico Brunetti
Division of Infectious and Tropical Diseases, IRCSS S. Matteo, University of Pavia Pavia, Italy
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Carlo Filice
Division of Infectious and Tropical Diseases, IRCSS S. Matteo, University of Pavia Pavia, Italy
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Peter Schantz
US Centers for Disease Control and Prevention, Atlanta, Ga.
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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 intra-cystic 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dissemination, some reports have addressed this aspect.4 Our findings from patients followed up for more than 10 years (unpublished data), based on whole body CT scanning performed on 5 patients show no signs of dissemination or recurrence in the peritoneum or at any other site.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.

References

  1. ↵
    1. Losanoff JE,
    2. Jones JW,
    3. Richman BW
    . Percutaneous drainage for liver hydatid cysts [letter]. Can J Surg 2002;45(1):69–70.
    OpenUrl
  2. ↵
    1. Castellano G,
    2. Moreno-Sanchez D,
    3. Gutierrez J,
    4. Moreno-Gonzalez E,
    5. Colina F,
    6. Solis-Herruzo JA
    . Caustic sclerosing cholangitis. Report of four cases and a cumulative review of the literature [review]. Hepatogastroenterology 1994;41(5):458–70.
    OpenUrlPubMed
  3. ↵
    1. Filice C,
    2. Brunetti E
    . Use of PAIR in human cystic echinococcosis. Acta Trop 1997;64(1–2):95–107.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Giorgio A,
    2. Tarantino L,
    3. de Stefano G,
    4. Francica G,
    5. Mariniello N,
    6. Farella N,
    7. et al
    . Hydatid liver cyst: an 11-year experience of treatment with percutaneous aspiration and ethanol injection . J Ultrasound Med 2001;20(7):729–38.
    OpenUrlAbstract
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In this issue

Canadian Journal of Surgery: 45 (5)
CAN J SURG
Vol. 45, Issue 5
1 Oct 2002
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Correspondence
Enrico Brunetti, Carlo Filice, Peter Schantz
CAN J SURG Oct 2002, 45 (5) 388;

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