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Efficacy and Safety of PAIR for Cystic Echinococcosis: Experience on a Large Series of Patients from Bulgaria

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  • Clinical Center of Gastroenterology, University Hospital Queen Joanna—Institute for Specialization and Improvement of Medical Doctors, Sofia, Bulgaria; Department of Parasitology and Tropical Medicine, Medical University—Plovdiv, Plovdiv, Bulgaria; Division of Infectious and Tropical Diseases and World Health Organization Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, San Matteo Hospital Foundation, Pavia, Italy

We report our experience with puncture, aspiration, injection, and reaspiration (PAIR) for the treatment of cystic echinococcosis in Bulgaria. PAIR was performed in 230 patients with 348 echinococcal cysts. At 12-month follow-up, 77.6% of the cysts, all cystic echinococcosis (CE) 1 and CE3a cysts according to the World Health Organization Informal Working Group classification, showed various degrees of obliteration. In 11.5% of cysts, all of which were > 10 cm-type CE1, a significant amount of fluid persisted, and they were punctured again. Of those, 16 (4.6%) contained protoscolices and were treated by a second PAIR. The remaining 24 (6.9%) cysts were treated by simple aspiration or drainage. No significant reduction in size and no changes in the structure were observed in 10.9% of cysts, all of which were classified as CE2 or CE3b. Complications developed in 25.2% of patients, including severe anaphylactic reaction in two (0.9%) patients. Our experience confirms that PAIR is a successful first-choice treatment when a stage-specific approach is taken.

Author Notes

*Address correspondence to Enrico Brunetti, Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, University of Pavia, Via Taramelli 5, 27100 Pavia, Italy. E-mail: selim@unipv.it

Authors' addresses: Branimir Golemanov, Nikola Grigorov, Rumiana Mitova, and Jordan Genov, Clinical Center of Gastroenterology, University Hospital Queen Joanna—Institute for Specialization and Improvement of Medical Doctors, Sofia, Bulgaria, E-mails: bgolemanov@yahoo.com, ultrasound.bg@gmail.com, rumi.mitova@gmail.com, and jordan.georgiev.genov@gmail.com. Dimitar Vuchev, Department of Parasitology and Tropical Medicine, Medical University—Plovdiv, Plovdiv, Bulgaria, E-mail: dvutchev@yahoo.com. Francesca Tamarozzi and Enrico Brunetti, Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy, E-mails: f_tamarozzi@yahoo.com and selim@unipv.it.

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