New Options in the Management of Cystic Echinococcosis - A Single Centre Experience Using Minimally Invasive Techniques.

OBJECTIVE: The aim of this study is to verify if the experience on 4 years in using minimally invasive techniques in the treatment of CE could match regarding the indications and results with the major studies on topic. METHOD: During 03.2014 - 03. 2018 period, 38 PAIR, 28 MoCaT procedures and 7 percutaneous drainages have been performed at 51 patients from 76 cases of hydatid hepatic cysts (67,1%). There were 26 men and 25 women, and the age ranged from 19 to 78. 7 patients have had 2 hydatid hepatic cysts or more and 2 procedures were performed at 3 of those patients; other 11 patients needed the second procedure during the surveillance. Results: The evolution of the patients was favorable, and the surveillance was 2 years postintervention at least. There were no major surgical adverse effects. We defined as an expected result obtaining a scar lesion or a small cavity with calcified walls (hyperechoic). Only 2 (3,9%) patients needed conversion to open surgery. The complications we have faced were represented by the cystic-biliary fistula in 15 cases (29,4%) and the re-opening of the cyst's cavity in 11 cases (21,67%). Conclusions: The percutaneous treatment of CE is safe and effective, following the correct assignation according with the cysts type. The percutaneous treatment of CE is an easier alternative to the open surgery and has lower rate of complications and relapses, and a shorter hospitalisation. Now routine, it becomes slighty the first option for invasive treatment of CE. The role of open surgery is restricted to CE with severe complications.

Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey: a cross-sectional, ultrasound-based, population study from the HERACLES project.

BACKGROUND: Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey. METHODS: We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference. FINDINGS: From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces. INTERPRETATION: Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control. FUNDING: European Union Seventh Framework Programme.