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Kuehn, Rebecca, Uchiumi, Leonardo J and Tamarozzi, Francesca (2024) 'Treatment of uncomplicated hepatic cystic echinococcosis (hydatid disease).'. Cochrane Database of Systematic Reviews, Vol 7, Issue 7, CD015573.
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Abstract
Background
Cystic echinococcosis is a parasitic infection mainly impacting people living in low‐ and middle‐income countries. Infection may lead to cyst development within organs, pain, non‐specific symptoms or complications including abscesses and cyst rupture. Treatment can be difficult and varies by country. Treatments include oral medication, percutaneous techniques and surgery.
One Cochrane review previously assessed the benefits and harms of percutaneous treatment compared with other treatments. However, evidence for oral medication, percutaneous techniques and surgery in specific cyst stages has not been systematically investigated and the optimal choice remains uncertain.
Objectives
To assess the benefits and harms of medication, percutaneous and surgical interventions for treating uncomplicated hepatic cystic echinococcosis.
Search methods
We searched CENTRAL, MEDLINE, two other databases and two trial registries to 4 May 2023. We searched the reference lists of included studies, and contacted experts and researchers in the field for relevant studies.
Selection criteria
We included randomized controlled trials (RCTs) in people with a diagnosis of uncomplicated hepatic cystic echinococcosis of World Health Organization (WHO) cyst stage CE1, CE2, CE3a or CE3b comparing either oral medication (albendazole) to albendazole plus percutaneous interventions, or to surgery plus albendazole. Studies comparing praziquantel plus albendazole to albendazole alone prior to or following an invasive intervention (surgery or percutaneous treatment) were eligible for inclusion.
Data collection and analysis
We used standard Cochrane methods. Our primary outcomes were symptom improvement, recurrence, inactive cyst at 12 months and all‐cause mortality at 30 days. Our secondary outcomes were development of secondary echinococcosis, complications of treatment and duration of hospital stay. We used GRADE to assess the certainty of evidence.
Main results
We included three RCTs with 180 adults and children with hepatic cystic echinococcosis. Two studies enrolled people aged 5 to 72 years, and one study enrolled children aged 6 to 14 years. One study compared standard catheterization plus albendazole with puncture, aspiration, injection and re‐aspiration (PAIR) plus albendazole, and two studies compared laparoscopic surgery plus albendazole with open surgery plus albendazole. The three RCTs were published between 2020 and 2022 and conducted in India, Pakistan and Turkey. There were no other comparisons.
Standard catheterization plus albendazole versus PAIR plus albendazole
The cyst stages were CE1 and CE3a.
The evidence is very uncertain about the effect of standard catheterization plus albendazole compared with PAIR plus albendazole on cyst recurrence (risk ratio (RR) 3.67, 95% confidence interval (CI) 0.16 to 84.66; 1 study, 38 participants; very low‐certainty evidence).
The evidence is very uncertain about the effects of standard catheterization plus albendazole on 30‐day all‐cause mortality and development of secondary echinococcosis compared to open surgery plus albendazole. There were no cases of mortality at 30 days or secondary echinococcosis (1 study, 38 participants; very low‐certainty evidence).
Major complications were reported by cyst and not by participant. Standard catheterization plus albendazole may increase major cyst complications compared with PAIR plus albendazole, but the evidence is very uncertain (RR 10.74, 95% CI 1.39 to 82.67; 1 study, 53 cysts; very low‐certainty evidence).
Standard catheterization plus albendazole may make little to no difference on minor complications compared with PAIR plus albendazole, but the evidence is very uncertain (RR 1.03, 95% CI 0.60 to 1.77; 1 study, 38 participants; very low‐certainty evidence).
Standard catheterization plus albendazole may increase the median duration of hospital stay compared with PAIR plus albendazole, but the evidence is very uncertain (4 (range 1 to 52) days versus 1 (range 1 to 15) days; 1 study, 38 participants; very low‐certainty evidence).
Symptom improvement and inactive cysts at 12 months were not reported.
Laparoscopic surgery plus albendazole versus open surgery plus albendazole
The cyst stages were CE1, CE2, CE3a and CE3b.
The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on cyst recurrence in participants with CE2 and CE3b cysts compared to open surgery plus albendazole (RR 3.00, 95% CI 0.13 to 71.56; 1 study, 82 participants; very low‐certainty evidence). The second study involving 60 participants with CE1, CE2 or CE3a cysts reported no recurrence in either group.
The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on 30‐day all‐cause mortality in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole. There was no mortality in either group (2 studies, 142 participants; very low‐certainty evidence).
The evidence is very uncertain about the effect of laparoscopic surgery plus albendazole on major complications in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole (RR 0.50, 95% CI 0.13 to 1.92; 2 studies, 142 participants; very low‐certainty evidence).
Laparoscopic surgery plus albendazole may lead to slightly fewer minor complications in participants with CE1, CE2, CE3a or CE3b cysts compared to open surgery plus albendazole (RR 0.13, 95% CI 0.02 to 0.98; 2 studies, 142 participants; low‐certainty evidence).
Laparoscopic surgery plus albendazole may reduce the duration of hospital stay compared with open surgery plus albendazole (mean difference (MD) −1.90 days, 95% CI −2.99 to −0.82; 2 studies, 142 participants; low‐certainty evidence).
Symptom improvement, inactive cyst at 12 months and development of secondary echinococcosis were not reported.
| Item Type: | Article |
|---|---|
| Subjects: | QX Parasitology > QX 20 Research (General) WC Communicable Diseases > Tropical and Parasitic Diseases > WC 840 Echinococcosis |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1002/14651858.CD015573 |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 06 Aug 2024 14:09 |
| Last Modified: | 06 Aug 2024 14:10 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/24997 |
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