Rationale and Objectives
To investigate the efficacy and safety of percutaneous treatment in cystic echinococcosis
(CE) type 1 and 3a giant cysts (with at least one diameter>10 cm) according to the
World Health Organization classification and to evaluate the management of complications,
especially cystobiliary fistulas (CBFs).
Materials and Methods
This retrospective study included 66 patients with 68 CE1 and CE3a giant cysts treated
with percutaneous catheterization between January 2016 and December 2021. The characteristics
of the cysts, major and minor complications, time to catheter removal, and length
of hospital stay were recorded.
Results
Among the 68 cysts, CBFs occurred in 35 (51.5%), cavity infections in 11 (16.1%),
recollection in five (7.4%), and anaphylaxis in three (4.5%). There was no mortality.
Biliary drainage was observed intraoperatively in 20 (29.4%) and only postoperatively
in 15 (22.1%) of the 35 cysts with CBFs. A plastic biliary stent was placed in 18
(51.5%) of the 35 cysts with CBFs. The patients with CBFs had a longer hospital stay
and time to catheter removal than those without fistulas (15.3 ± 10.9 vs. 6.1 ± 2.6
days and 32.7 ± 51.8 vs. 6.2 ± 3.1 days, respectively; P < 0.001). Of the patients
who developed recollection, three were treated with secondary catheterization, and
two underwent surgery. In total, three patients underwent surgery. The rate of clinical
success was 95.4%. All cysts were followed up for an average of 19.1 (range, 12–60)
months, and there was an average 88.8% reduction in cyst volume compared to the initial
evaluation.
Conclusion
CE1 and CE3a giant cysts can be treated effectively and safely with high clinical
success using the catheterization technique. Contrary to what has previously been
reported for these patients, the rate of CBFs is high, but these patients can successfully
be treated with percutaneous drainage and/or endoscopic retrograde cholangiopancreatography
without the requirement of surgery.
Key Words
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Article info
Publication history
Published online: April 28, 2023
Accepted:
March 21,
2023
Received in revised form:
March 19,
2023
Received:
February 19,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved All rights reserved.
