An Alternative Method for Percutaneous Treatment Of Hydatid Cysts: PAI Technique

Abstract

Objective: Surgery is still the first choice in complicated cystic echinococcosis. However, percutaneous methods have performed increasingly in recent years. The Puncture, Aspiration, Injection, Reaspiration (PAIR) technique is mostly the preferred percutaneous method. The Puncture, Aspiration, Injection (PAI) technique is the new modified method, which is differentiated from PAIR technique by its applicability to all types of hydatid cysts (types 1-5) and unperforming of reaspiration. Methods: The 52 hydatid cysts were prospectively examined in the study. Thirty-four of them were Types I and II, 13 of them were Type III, and 5 of them were Types IV and V. The technique was performed using the 20 G Chiba needle under the guidance of ultrasonography. Maximum cyst contents were aspirated immediately after the puncture to reduce the intracystic pressure. After confirming that aspirated liquid does not contain bile and that cyst has no cystobiliary connection, 95% alcohol was injected into the cavity, safely. Reaspiration of alcohol was not performed. Results: The cyst sizes were reduced after PAI on ultrasonographic evaluations in all cases. The liquid component disappeared and the cyst got solid characteristic three months after the procedure. Conclusion: All hydatid cyst types can be treated safely and effectively with PAI technique without considering dimensions and whether. Keywords: Cyst hydatid, therapeutic, methods Received: 26.04.2015Accepted: 14.04.2016 ÖZ Amaç: Cerrahi komplike kistik ekinokokkoziste hala ilk seçenektir. Buna ragmen son yıllarda perkütan metodlar daha sık uygulanmaktadır. PAIR (Giriş, Aspirasyon, İnjeksiyon, Reaspirasyon) tekniği çok sık uygulanan bir metodtur. PAI tekniği (Giriş, aspirasyon, İnjeksiyon) reaspirasyonun yapılmadığı ve tüm kist tiplerine (tip1-5) uygulanabilen yeni bir metodtur.Yöntemler: Prospektif olarak 52 hidatik kist olgusu çalışmaya alındı. Bunlardan 34'ü tip I-II, 13 tanesi tip III, 5 tanesi de tip IV ve V idi. Teknik ultrasonografi eşliğinde 20 G chiba ignesi kullanılarak yapıldı. Kist içine girer girmez kist basıncını düşürmek için maksimum içerik aspire edildi. Aspire edilen sıvıda bilier bağlantıyı gösteren safra sızıntısı olmadığından emin olduktan sonra kist kavitesi içine % 95 alkol verildi. Reaspirasyon yapılmadı. Bulgular: Üç ay sonraki ultrasonografik değerlendirmede tüm vakalarda kist boyutu küçüldü. Kistin likit komponenti kayboldu ve solit karakter kazandı. Sonuç: İçerisinde kız vezikül, yoğun septasyon varlığı ve kist boyutuna bakılmaksızın tüm hidatik kistler PAI tekniği ile güvenli ve etkili bir şekilde tedavi edilebilir.

Repeated Percutaneous Treatment of Massive Hepatic Cystic Echinococcosis in a Child

“…In described pediatric cohorts, surgical excision was the most frequently used procedure, which was applied in 98.3% and 98.0% of patients with CE, respectively, 5, 7 but solely medicamentous treatment of abdominal CE in children, applied in 54% of the patients with a mean duration of 142.5 days, was reported being highly effective. 6 Since first reported as a successful and safe procedure in 1985, 22 the percutaneous treatment of CE experienced many modifications, from the PAIR protocol recommended by WHO for CE1 and CE stage 3a cysts, 12 continuous catheter drainage for cysts larger than 10 cm, 19 Örmeci et al 23 modification of PAIR (outpatient basis, without albendazole prophylaxis, smaller needle of 22 gauge, procedure lasts 5 minutes), and puncture-aspiration-instillation (PAIR without the reaspiration step, applicable for CE1 through CE stage 5 cysts) 24 to a variety of procedures aimed to remove the entire endocyst and daughter cysts from CE2 and CE3b cysts (eg, percutaneous evacuation). 25 During percutaneous procedures, the longest possible transhepatic needle approach to the cyst is advised, to reduce the risk of intraperitoneal leakage of the infective material.…”

Shortage of Albendazole and Its Consequences for Patients with Cystic Echinococcosis Treated at a Referral Center in Italy

“…Currently, four clinical management options are available for the management of CE, depending on the affected organ and cyst size: medical therapy with benzimidazoles; surgery; percutaneous techniques, such as catheter-based procedures or the puncture-aspiration-injection-reaspiration technique 10 and its derivates; [11][12][13] and watch-and-wait. 7,14 Patients receiving surgery or percutaneous procedures for hepatic CE should receive ABZ from the day of the intervention to 1 month post-intervention to prevent secondary echinococcosis due to the dissemination of parasitic material.…”

Modern trends in surgical treatment of liver echinococcosis

“…В качестве гермицида авторы используют гипертонический раствор или 95% спирт. При контрольном исследовании через 3 мес отмечались УЗ-признаки гибели и организации кисты [44]. С 1992 г. в медицинском центре университета Анкары применяется методика N. Еrmeci.…”