Percutaneous hydatic cyst treatment in children: Technical differences and long-term follow-up results

Abstract

Purpose: To evaluate efficacy, safety and the long-term results of percutaneous imaging-guided treatment of hydatid cysts (HC) in children and to discuss the differences of applied percutaneous interventional techniques.

Materials And Methods: Between October 2009 and April 2014, 34 children with type WHO-CE1 and CE 3a, 60 HC underwent percutaneous treatment (PT). For 32 cysts smaller than 6 cm in longest diameter the method of treatment was PAIR, for 28 cysts with diameters larger than 6 cm the method of treatment was catheterization. Catheter was leaved to free drainage in 16 cysts, out of which 12 was ended in single session. All patients were followed first month and every 3 months during the 1st year, every 6 months during the 2nd year, and after then yearly. Results: PT of HC was successful in all patients. Mean volume reduction was 74.6 % with PAIR, 78.7 % with single session catheterization, and 57.9 % in catheterization – free drainage methods. Mean of hospitalization periods were 16 hours for both of those patients treated with the PAIR technique, and single session catheterization, 2.1 days for the patients treated by catheterization – free drainage. The mean follow-up was 93.6 months.

Conclusion: Percutaneous hydatid cyst treatment is a highly efficent, successful and safe procedure. PT should be prefered in WHO CE type 1 and 3a cysts especially in pediatrics. Performing the catheterization without keeping it in the cavity makes it advantegeous in pediatrics because of convenience of approach, low pain, high patient adherence, and short hospitalization period.

Keywords

• Children
• Hydatic Cyst
• Percutaneous Treatment

Çocuklarda Perkütan Kist Hidatik Tedavisi: Teknik Farklılıklar ve Uzun Dönem Takip Sonuçları

Abstract

Amaç: Çocuklarda perkütan yöntemle kist hidatik tedavisinin etkinliğinin, güvenirliğinin ve uzun dönem takip sonuçlarının değerlendirilmesi, uygulanan perkütan girişim tekniklerinin farklılıklarının tartışılması amaçlandı.

Gereç ve Yöntemler: Retrospektif olan çalışmamız hastanemiz akademik kurullundan onayı alınarak yapıldı. Çalışmaya, Ekim 2009 ve Nisan 2014 tarihleri arasında perkütan tedavi uygulanan WHO tip 1 ve 3a, toplam 60 kisti bulunan, 34 çocuk hasta (22 kız, 12 erkek; ortalama yaşları 9.1±3.2 yıl) dahil edildi. Çapı 6 cm’den küçük kistler “Puncture, Aspiration, Injection, Reaspiration” (PAIR) yöntemi ile, 6 cm’den büyük kistler kataterizasyon yöntemi ile (tek seansta veya kataterin serbest drenaja bırakılması şeklinde) tedavi edildi. Hastalar işlem sonrası 1. ay, ilk yıl 3 ayda bir, ikinci yıl 6 ayda bir ve sonra yıllık kontrollere çağrıldı.

Bulgular: Çapı 6 cm’den küçük 32 kist PAIR yöntemi ile, 6 cm’den büyük 28 kist ise kateterizasyon yöntemi ile tedavi edildi. On altı kistte katater serbest drenaja bırakılırken, 12 kistte işlem sonunda kateter çekilerek tedavi tek seansta sonlandırıldı. Perkütan tedavi tüm kist hidatiklerde başarı ile sonuçladı. Ortalama volüm kaybı PAIR yönteminde %74.6, tek seans kateterizasyonda %78.7, serbest drenaja bırakılmış kateterizasyonda ise % 57.9’du. Tek-seans kateterizasyon en etkin yöntem olarak saptandı ve bunu sırasıyla kateterizasyon ve PAIR yöntemleri izledi (p<0.000). Ortalama hastanede kalış süresi PAIR ve tek seans kateterizasyon yöntemlerinde 16 saat, serbest drenaja bırakılmış kateterizasyon yönteminde ise 2.1 gündü. Ortalama takip süresi 93.6 aydı.

Sonuç: Perkütan kist hidatik tedavisi oldukça etkin, başarılı ve güvenilir bir yöntemdir. Özellikle çocuklarda, tip 1 ve tip 3a kistlerde tercih edilmelidir. İşlem sırasında konforu, işlem sonrası ağrının azlığı, yüksek hasta uyumu nedeniyle tek seans kateterizasyon çocuklarda oldukça avantajlıdır.

Keywords

• Çocuk
• Kist hidatik
• Perkütan tedavi

References

1. 1. Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. ActaTrop 2010; 114: 1-16.
2. 2. WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003; 85: 253-261.
3. 3. Akhan O, Canyigit M, Kaya D, Koksal A, Akgoz A, Yucesoy C, et al. Long-term follow-up of the percutaneous treatment of hydatid cyst in the adrenal gland: a case report and review of the literature. Cardiovasc Intervent Radiol 2011; 34: 256-259.
4. 4. Akhan O, Koroglu M. Hydatid disease of the spleen. Semin Ultrasound CT MR 2007; 28: 28-34.
5. 5. Ben Amor N,Gargouri M,Gharbi HA, Ghorbel A, Golvan YJ, Hammou-Jeddi H, et al. Traitement du kyste hydatique du foie du mouton par ponction sous échographie [Treatment of hepatic hydatid cyst in sheep by echographic puncture]. Tunis Med 1986; 64: 325-331.
6. 6. Akhan O, Dincer A, Gokoz A, Sayek I, Havlioglu S, Abbasoglu O, et al. Percutaneous treatment of abdominal hydatid cysts with hipertonic saline and alcohol. An experimental study in sheep. Invest Radiol 1993; 28: 121-127.
7. 7. Ustunsoz B, Akhan O, Kamiloglu MA, Somuncu I, Ugurel MS, Cetiner S. Percutaneous treatment of hydatid cysts of the liver: long-term results. AJR Am J Roentgenol 1999;172: 91-96.
8. 8. Khuroo MS, Wani NA, Javid G, Khan BA, Yattoo GN, Shah AH, et al. Percutaneous drainage compared with surgery for hepatic hydatid cyst. N Engl J Med 1997; 337: 881-887.

9. 9. Brunetti E, Garcia HH, Junghanss T; International CE Workshop in Lima, Peru, 2009. Cystic echinococcosis: chronic, complex, and still neglected. PLoS Negl Trop Dis 2011; 5(7):e1146.
10. 10. Nunnari G, Pinzone M R, Gruttadauria S, Celesia BM, Madeddu G, Malaguarnera G, et al. Hepatic echinococcosis: clinical and therapeutic aspects. World J Gastroenterol 2012; 18:1448-1458.
11. 11. Gargouri M, Ben Amor N, Ben Chehida F, Hammou A, Gharbi HA, Ben Cheikh M, et al. Percutaneous treatment of hydatid cysts (Echinococcus granulosus). Cardiovasc Intervent Radiol 1990;13: 169-173.
12. 12. Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology 1981;139: 459-463.
13. 13. Turgut AT, Akhan O, Bhatt S, Dogra VS. Sonographic spectrum of hydatid disease. Ultrasound Q 2008; 24:17-29.
14. 14. Kapan S, Turhan AN, Kalayci MU, Alis H, Aygun E. Albendazole is not effective for primary treatment of hepatic hydatid cysts. J Gastrointest Surg 2008;12: 867-871.
15. 15. Chai J, Menghebat, Jiao W, Sun D, Liang B, Shi J, Fu C, et al. Clinical efficacy of albendazole emulsion in treatment of 212 cases of liver cystic hydatidosis. Chin Med J 2002; 115: 1809-1813.
16. 16. Akhan O, Yildiz AE, Akinci D, Yildiz BD, Ciftci T. Is the adjuvant albendazole treatment really needed with pair in the management of liver hydatid cysts? A prospective, randomized trial with short-term follow-up results. Cardiovasc Intervent Radiol 2014; 37: 1568-1574.
17. 17. Odev K, Paksoy Y, Arslan A, Aygün E, Sahin M, Karaköse S, et al. Sonographically guided percutaneous treatment of hepatic hydatid cysts: Long-term results. J Clin Ultrasound 2000; 28: 469-478.
18. 18. Giorgio A, Di Sarno A, De Stefano G, Farella N, Matteucci P, Scognamiglio U, et al. Percutaneous treatment of hydatid liver cyst. Recent Pat Antiinfect Drug Discov 2009; 4:29-36.
19. 19. Kabaalioglu A, Karaali K, Apaydin A, Melikoglu M, Sindel T, Luleci E. Ultrasound-guided percutaneous sclerotherapy of hydatid liver cysts in children. Pediatr Surg Int 2000; 16: 346-350.
20. 20. Celebi F, Balik AA, Salman B, Oren D. Hydatid disease in childhood. Pediatr Surg Int 2002; 18: 417-419.
21. 21. Yagci G, Ustunsoz B, Kaymakcioglu N, Bozlar U, Gorgulu S, Simsek A, et al. Results of surgical, laparoscopic, and percutaneous treatment for hydatid disease of the liver: 10 years experience with 355 patients. World J Surg 2005;29(12):1670-1679.
22. 22. Polat KY, Balik AA, Oren D. Percutaneous drainage of hydatid cyst of the liver: long-term results. HPB (Oxford) 2002; 4: 163-166.
23. 23. Kabaalioglu A, Ceken K, Alimoglu E, Apaydın A. Percutaneous imaging-guided treatment of hydatid liver cysts:Do long-term results make it a first choice? European J Radiol 2006; 59:65-73.
24. 24. Giorgio A, de Stefano G, Esposito V, Liorre G, Di Sarno A, Giorgio V, et al. Long-term results of percutaneous treatment of hydatid liver cysts: a single center 17 years experience. Infection 2008; 36: 256-261.
25. 25. Filice C, Stroselli M, Brunetti E, Colombo P, D'Andrea F. Percutaneous drainage of hydatid liver cysts. Radiology 1992;184: 579-580.
26. 26. Kahriman G, Ozcan N, Donmez H. Hydatid cysts of the liver in children: percutaneous treatment with ultrasound follow-up. Pediatr Radiol 2011; 41: 890-894.
27. 27. Smego RA Jr, Bhatti S, Khaliq AA, Beg MA. Percutaneous aspiration-injection-reaspiration drainage plus albendazole or mebendazole for hepatic cystic echinococcosis: a meta-analysis. Clin Infect Dis 2003; 37: 1073-1083.
28. 28. Nasseri-Moghaddam S, Abrishami A, Taefi A, Malekzadeh R. Percutaneous needle aspiration, injection, and re-aspiration with or without benzimidazole coverage for uncomplicated hepatic hydatid cysts. The Cochrane Library 2011, Issue 1 http://www.thecochranelibrary.com
29. 29. Giorgio A, Tarantino L, Francica G, Mariniello N, Aloisio T, Soscia E, et al. Unilocular hydatid liver cysts: treatment with US-guided double percutaneous aspiration and alcohol injection. Radiology 1992; 184: 705-710.
30. 30. Akhan O, Erdogan E, Ozmen M, et al. Comparison of the effectiveness of PAIR and catheterization techniques for the percutaneous treatment of liver hydatid cysts: a prospective randomized study. Presented at CIRSE 2004; 166: 46.
31. 31. Dilsiz A, Acikgozoglu S, Gunel E, Dağdönderen L, Köseoğlu B, Gündoğan AH. Ultrasound-guided percutaneous drainage in the treatment of children with hepatic hydatid disease. Pediatr Radiol 1997; 27: 230-233.
32. 32. Goktay AY, Secil M, Gulcu A, Hosgor M, Karaca I, Olguner M, et al. Percutaneous treatment of hydatid liver cysts in children as a primary treatment: long-term results. J Vasc Interv Radiol 2005;16: 831-839.