Comparative Response of Pair with or without Oral Albendazole in Hepatic Hydatid Disease

Background and Aim: Hydatid disease of the liver is endemic in cattle rearing areas of the world including Asia. The common treatment options include nonsurgical (antihelminthic drugs, PAIR) methods and surgery. Various studies have shown promising results with PAIR with or without antihelminthic drugs. This study was undertaken to assess response of nonsurgical treatment of PAIR with or without Albendazole in hydatid disease.Method: This study was carried out in Department of Gastroenterology, IMS, BHU, Varanasi, from January 2012 to December 2014. 85 patients (F:M—1.42:1, mean age 48 years) with hepatic hydatid disease fulfilling inclusions criteria's were enrolled in the study . Patients were randomized into 2 groups according to treatment by PAIR with Albendazole (for 7 days and 3 months pre- and post-PAIR) (Group 1, 47 patients) and PAIR alone (Group 2, 38 patients), followed up for 1 year. PAIR was done under ultrasound guidance with aseptic precaution with Hypertonic Saline (20%). Post-therapeutic response was assessed by viability of protoscolex, solidification and reduction in cyst size, calcification of wall, echogenicity, and pseudomass appearance on ultrasound at 1, 3, 6, and 12 months.Result: In a total of 85 patients (125 cysts), 54 patients were having single cyst, 2 cysts in 22 patients, and 3 in 9 patients, respectively. A total of 67 cysts (53.6%) belonged to CE1, 31 (24.8%) to CE2 and 27 (21.6%) to CE3 as per WHO classification. Success rate was 78%, 83%, 88% and 93.8% and 38%, 42%, 46% and 54% for 1, 3, 6, and 12 months in groups 1 and 2, respectively (P < .01). Major reactions occurred in 1.2% patients and minor reactions occurred 16% of PAIR-treated subjects.Conclusion: PAIR with Albendazole is an effective treatment of hepatic hydatid cysts as compared to PAIR alone having higher success rate. Background and Aim: Hydatid disease of the liver is endemic in cattle rearing areas of the world including Asia. The common treatment options include nonsurgical (antihelminthic drugs, PAIR) methods and surgery. Various studies have shown promising results with PAIR with or without antihelminthic drugs. This study was undertaken to assess response of nonsurgical treatment of PAIR with or without Albendazole in hydatid disease. Method: This study was carried out in Department of Gastroenterology, IMS, BHU, Varanasi, from January 2012 to December 2014. 85 patients (F:M—1.42:1, mean age 48 years) with hepatic hydatid disease fulfilling inclusions criteria's were enrolled in the study . Patients were randomized into 2 groups according to treatment by PAIR with Albendazole (for 7 days and 3 months pre- and post-PAIR) (Group 1, 47 patients) and PAIR alone (Group 2, 38 patients), followed up for 1 year. PAIR was done under ultrasound guidance with aseptic precaution with Hypertonic Saline (20%). Post-therapeutic response was assessed by viability of protoscolex, solidification and reduction in cyst size, calcification of wall, echogenicity, and pseudomass appearance on ultrasound at 1, 3, 6, and 12 months. Result: In a total of 85 patients (125 cysts), 54 patients were having single cyst, 2 cysts in 22 patients, and 3 in 9 patients, respectively. A total of 67 cysts (53.6%) belonged to CE1, 31 (24.8%) to CE2 and 27 (21.6%) to CE3 as per WHO classification. Success rate was 78%, 83%, 88% and 93.8% and 38%, 42%, 46% and 54% for 1, 3, 6, and 12 months in groups 1 and 2, respectively (P < .01). Major reactions occurred in 1.2% patients and minor reactions occurred 16% of PAIR-treated subjects. Conclusion: PAIR with Albendazole is an effective treatment of hepatic hydatid cysts as compared to PAIR alone having higher success rate.