Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2024; 30(5): 462-470
Published online Feb 7, 2024. doi: 10.3748/wjg.v30.i5.462
Diagnosis and treatment experience of atypical hepatic cystic echinococcosis type 1 at a tertiary center in China
Yu-Peng Li, Jie Zhang, Zhi-De Li, Chao Ma, Guang-Lei Tian, Yuan Meng, Xiong Chen, Zhi-Gang Ma
Yu-Peng Li, Jie Zhang, Zhi-De Li, Chao Ma, Guang-Lei Tian, Yuan Meng, Xiong Chen, Zhi-Gang Ma, Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
Author contributions: Li Y designed and performed the research and wrote the manuscript; Ma Z designed the research and supervised the manuscript preparation; Zhang J, Li Z, and Ma C designed the research and contributed to the data analysis; Tian G, Meng Y, and Chen X provided clinical advice; all authors have read and approved the final manuscript to be published.
Institutional review board statement: The protocol was approved by the Ethics Committee of People's Hospital of Xinjiang Uygur Autonomous Region, China.
Informed consent statement: The informed consent was obtained from the subject(s) and/or guardian(s).
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset are accessible through the corresponding author. Participants provided informed consent for sharing their data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Zhi-Gang Ma, MD, Doctor, Professor, Department of Hepatobiliary Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, Urumqi 830000, Xinjiang Uygur Autonomous Region, China.
Received: November 1, 2023
Peer-review started: November 1, 2023
First decision: December 6, 2023
Revised: December 19, 2023
Accepted: January 11, 2024
Article in press: January 11, 2024
Published online: February 7, 2024
Research background

Given the distinct biological features of this disease, only a few patients with hepatic echinococcosis can receive standardized diagnosis and treatment. Some patients with cystic echinococcosis type 1 (CE1) exhibit atypical clinical manifestations, and findings from laboratory tests and radiographic examinations may not align with typical patterns. In specific cases of CE1, hydatid cysts may lack clearly defined cyst walls or characteristic endocysts. It is challenging to differentiate these lesions from simple hepatic cysts. Erroneous diagnosis and treatment of atypical CE1 may lead to grim consequences.

Research motivation

Developing appropriate diagnostic and therapeutic approaches for atypical CE1 hydatid cysts is of great importance.

Research objectives

The purpose of this study was to improve the diagnostic rate of atypical CE1. Laparoscopic procedures were performed to verify the diagnosis of atypical CE1 and to deliver a less invasive treatment, in order to reduce the misdiagnosis rate and the risks associated with potential delays in treatment.

Research methods

Ninety-three patients who received treatments for simple hepatic cysts at the People's Hospital of Xinjiang Uygur Autonomous Region (Urumqi, China) from January 2018 to September 2023 were enrolled in the study. The clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis, routine abdominal ultrasound, high-frequency ultrasound, abdominal computed tomography (CT) scanning, and laparoscopy. Subsequent to treatments, patients with CE were followed up once every 3-6 months, and those with simple hepatic cysts once every 6-12 months. Patients underwent abdominal ultrasound and liver function tests during the follow-up period until October 2023.

Research results

Among the 93 patients, 21 and 72 patients were CE-positive and CE-negative, respectively. All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scanning. Among them, 16 patients were preoperatively diagnosed with atypical CE1, and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound. All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy, of whom 14 patients were intraoperatively confirmed to have CE1, which was consistent with the postoperative pathological diagnosis, one patient was diagnosed with a mesothelial cyst of the liver, and the other was diagnosed with a hepatic cyst combined with local infection. Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts, 4 received aspiration sclerotherapy of hepatic cysts, and 19 received laparoscopic fenestration. These patients were intraoperatively diagnosed with simple hepatic cysts. During the follow-up period, none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices. One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space.

Research conclusions

Abdominal high-frequency ultrasound can detect CE1 hydatid cysts. Laparoscopy serves as an effective diagnostic and therapeutic tool for CE.

Research perspectives

Our findings remain to be further verified by randomized clinical trials.