Editorial
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World J Gastroenterol. Sep 7, 2010; 16(33): 4123-4129
Published online Sep 7, 2010. doi: 10.3748/wjg.v16.i33.4123
Treatment of liver hydatidosis: How to treat an asymptomatic carrier?
Bernardo Frider, Edmundo Larrieu
Bernardo Frider, Department of Medicine-Hepatology, Argerich Hospital, University of Buenos Aires, Maimonides University, Salguero 2601, 1425 Buenos Aires, Argentina
Edmundo Larrieu, Department of Zoonosis, Ministry of Health of Rio Negro Province, Laprida 240, 8500 Viedma, Argentina; University of La Pampa, Calle 5 y 116, 6360 General Pico, Argentina
Author contributions: Both authors contributed to the writing and correction of the manuscript.
Correspondence to: Bernardo Frider, MD, Professor, Department of Medicine-Hepatology, Argerich Hospital, University of Buenos Aires, Maimonides University, Salguero 2601, 1425 Buenos Aires, Argentina. bernardo@frider.com.ar
Telephone: +54-11-48010502 Fax: +54-11-48010502
Received: April 19, 2010
Revised: May 23, 2010
Accepted: May 30, 2010
Published online: September 7, 2010
Abstract

Liver hydatidosis is the most common clinical presentation of cystic echinococcosis (CE). Ultrasonographic mass surveys have demonstrated the true prevalence, including the asymptomatic characteristic of the majority of cases, providing new insight into the natural history of the disease. This raises the question of whether to treat or not to treat these patients, due to the high and unsuspected prevalence of CE. The high rate of liver/lung frequencies of cyst localization, the autopsy findings, and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion. The decision to treat an asymptomatic patient by surgery, albendazole, or puncture aspiration injection and reaspiration or to wait and watch, is based on conflicting reports in the literature, the lack of complications in untreated patients over time, and the spontaneous disappearance and involution of cysts. All these points contribute to difficulties of individual clinical decisions. The patients should be informed of the reasons and the risks of watchful/waiting without treatment, the possibility of complications, and the risks of the other options. As more information on the natural history of liver hydatidosis is acquired, selection of the best treatment will be come easier. Without this knowledge it would be very difficult to establish definitive rules of treatment. At present, it is possible to manage these patients over time and to wait for the best moment for treatment. Follow-up studies must be conducted to achieve this objective.

Keywords: Hydatid cyst; Liver; Hepatic cystic echinococcosis; Albendazole; Liver ultrasonography; Puncture aspiration injection and reaspiration; Ultrasonography screening; Asymptomatic liver hydatidosis