Review
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2014; 6(5): 293-305
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.293
Cystic echinococcosis of the liver: A primer for hepatologists
Francesca Rinaldi, Enrico Brunetti, Andreas Neumayr, Marcello Maestri, Samuel Goblirsch, Francesca Tamarozzi
Francesca Rinaldi, Enrico Brunetti, Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, 27100 Pavia, Italy
Francesca Rinaldi, Enrico Brunetti, Francesca Tamarozzi, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, 27100 Pavia, Italy
Andreas Neumayr, Swiss Tropical and Public Health Institute, 4002 Basel, Switzerland
Andreas Neumayr, University of Basel, 4003 Basel, Switzerland
Marcello Maestri, Division of General Surgery, University of Pavia, San Matteo Hospital Foundation, 27100 Pavia, Italy
Samuel Goblirsch, Emergency Medicine, Winona Health Services, Winona, MN 55987, United States
Author contributions: All the authors reviewed the literature and wrote the manuscript; Goblirsch S edited the paper.
Supported by The EU grant FP7/2007-2013, No. 602051 - HERACLES (to Brunetti E)
Correspondence to: Enrico Brunetti, MD, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, WHO Collaborating Centre for the Clinical Management of Cystic Echinococcosis, 27100 Pavia, Italy. enrico.brunetti@unipv.it
Telephone: +39-382-502159 Fax: +39-382-924590
Received: November 12, 2013
Revised: January 22, 2014
Accepted: March 17, 2014
Published online: May 27, 2014
Abstract

Cystic echinococcosis (CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptomatic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the ”watch and wait” approach for inactive cysts. Allocation of patients to these treatments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosis and the currently available evidence for clinical decision-making in cystic echinococcosis of the liver.

Keywords: Cystic echinococcosis, Hydatidosis, Clinical management, Diagnosis, Treatment, Surgery, Albendazole, Watch-and-wait, Follow-up, Percutaneous treatment

Core tip: Cystic echinococcosis (CE) is a neglected parasitic disease and echinococcal cysts are mostly located in the liver. Therefore, CE should always be included in the differential diagnosis of cystic lesions of the liver. However, diagnosis and clinical management can be difficult because of the combination of clinical variables (cysts stage, size, presence of complications, available expertise and three different treatments that have never been systematically compared). This review summarizes current knowledge and open issues in this field for those hepatologists who have limited or no experience with this complex condition.