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Percutaneous Management of Extrahepatic Cystic Echinococcosis: Long-Term Outcomes and Insights on Rare Locations
Guven Kahriman1, Muhammed Musa Onem1, Gamze Talih2
1Department of Radiology, Gevher Nesibe Hospital, Medical Faculty, Erciyes University, Kayseri, Turkey.
Insights
Percutaneous treatment for extrahepatic Cystic Echinococcosis (CE) is highly effective and safe. This minimally invasive approach offers organ preservation and low recurrence rates for hydatid cysts.
Area of Science:
- Medical Imaging and Intervention
- Parasitology
- Minimally Invasive Surgery
Background:
- Cystic Echinococcosis (CE) is a parasitic infection caused by Echinococcus granulosus.
- Extrahepatic CE involves hydatid cysts located outside the liver, presenting diverse clinical challenges.
- Percutaneous treatment offers a less invasive alternative to traditional surgery for CE management.
Purpose of the Study:
- To assess the efficacy and safety of percutaneous techniques for treating various types of extrahepatic Cystic Echinococcosis.
- To evaluate outcomes across different cyst locations and stages treated with percutaneous methods.
Main Methods:
- A retrospective analysis of 31 patients with 32 extrahepatic hydatid cysts treated percutaneously.
- Patients received either the PAIR (puncture, aspiration, injection, reaspiration) procedure or the modified catheterization technique (MoCaT) with sclerotherapy.
- Cysts were located in diverse sites including spleen, intramuscular, peritoneal, and renal regions.
Main Results:
- High clinical success rate of 96.9% with minimal residual disease.
- Significant median cyst volume reduction of 83.2%.
- Low rates of severe adverse events (6.5%) and no recurrences during a median follow-up of 36 months.
Conclusions:
- Percutaneous management of extrahepatic CE is a safe and effective minimally invasive option.
- This approach preserves organ function and tissue, with favorable safety and recurrence profiles.
- Shorter hospital stays are an additional benefit of percutaneous CE treatment.
Purpose:
To evaluate the effectiveness of percutaneous treatment for all types of extrahepatic cystic echinococcosis (CE) in various atypical locations.
Materials And Methods:
This study included 31 patients (16 males and 15 females; median age, 46 years; range, 15-74 years) with 32 extrahepatic hydatid cysts treated percutaneously between July 2013 and September 2024. Splenic hydatid cysts constituted the largest subgroup (n = 12). The remaining cysts were located in various regions, including intramuscular (n = 5), peritoneal (n = 5), perirenal (n = 3), renal (n = 2), pancreatic (n = 1), paracolic (n = 1), paravesical (n = 1), sacral (n = 1), and infratemporal fossa (n = 1). Sixteen patients with CE1 and CE3a cysts underwent the puncture, aspiration, injection, and reaspiration (PAIR) procedure, whereas 15 patients with CE2 and CE3b cysts or symptomatic CE4 and CE5 cysts were treated with the modified catheterization technique (MoCaT), which involves the complete evacuation of cyst content via a catheter with saline irrigation, unlike PAIR, and is followed by sclerotherapy.
Results:
Clinical success was 96.9%, with 1 case of residual disease in the MoCaT group. Two severe adverse events (6.5%) were observed, one abscess requiring drainage and one anaphylaxis responsive to medical management. The median cyst volume reduction was 83.2% (range, 45.9%-100%). No recurrences occurred during a median follow-up of 36 months (range, 3-126 months).
Conclusions:
Percutaneous management of extrahepatic CE is a minimally invasive, effective and safe approach that offers advantages such as the preservation of organ tissue and function, low adverse event and recurrence rates, and shorter hospital stays.
