Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Department of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Swiss Med Wkly. 2023 Oct 6;153:40116. doi: 10.57187/smw.2023.40116.
Alveolar echinococcosis, an orphan zoonosis affecting the liver, is of increasing concern worldwide. Most symptomatic cases present at an advanced and inoperable stage, sometimes with biliary obstruction prompting biliary tract interventions. These are, however, associated with a high risk of infectious complications. The aim of this retrospective study was to compare the effectiveness and safety of conservative and interventional treatment approaches in patients with newly diagnosed alveolar echinococcosis and biliary obstruction.
Alveolar echinococcosis patients treated at two referral centres in Switzerland, presenting with hyperbilirubinaemia (total bilirubin >1.5 Upper Limit of Normal) at diagnosis were included, unless another underlying aetiology, i.e. common bile duct stones or decompensated cirrhosis, was identified. Patients were divided into two groups, according to whether they initially received a biliary tract intervention. The primary endpoint was normalisation of bilirubin levels within a 6-month period. Secondary endpoints included, among others, the occurrence of early and late biliary complications, the need for biliary tract interventions during follow-up and overall duration of hospital stays for treatment initiation and for biliary complications.
28 patients were included in this study, of whom 17 received benzimidazole therapy alone and 11 additionally received a biliary tract intervention. Baseline characteristics did not differ between groups. All but one patient in each group achieved the primary endpoint (p=0.747). Biliary tract intervention was associated with faster laboratory improvement (t1/2 1.3 vs 3.0 weeks), but also with more frequent early biliary complications (7/11 vs 1/17, p=0.002) and longer initial hospital stay (18 days vs 7 days, p=0.007).
Biliary obstruction in patients with newly diagnosed alveolar echinococcosis can be treated effectively with benzimidazole therapy alone. Biliary tract intervention, on the other hand, is associated with a high complication rate and should probably be reserved for patients with insufficient response to benzimidazole therapy.
泡型包虫病是一种影响肝脏的孤儿性动物源性传染病，在全球范围内受到越来越多的关注。大多数有症状的病例在晚期和不可手术阶段出现，有时伴有胆道梗阻，需要胆道介入治疗。然而，这些治疗方法存在很高的感染并发症风险。本回顾性研究的目的是比较新诊断的泡型包虫病合并胆道梗阻患者保守治疗和介入治疗方法的有效性和安全性。
瑞士两个转诊中心收治的新诊断为泡型包虫病且伴有高胆红素血症（总胆红素>1.5 正常值上限）的患者纳入本研究，除非存在其他潜在病因，如胆总管结石或失代偿性肝硬化。患者分为两组，一组患者最初接受胆道介入治疗，另一组仅接受苯并咪唑治疗。主要终点是在 6 个月内胆红素水平正常化。次要终点包括早期和晚期胆道并发症的发生、随访期间需要胆道介入治疗的情况以及治疗开始和胆道并发症的总住院时间。
本研究共纳入 28 例患者，其中 17 例仅接受苯并咪唑治疗，11 例患者同时接受胆道介入治疗。两组患者的基线特征无差异。每组均有除 1 例患者外的所有患者达到主要终点（p=0.747）。胆道介入治疗与更快的实验室改善相关（t1/2 分别为 1.3 周和 3.0 周），但也与更频繁的早期胆道并发症相关（7/11 例与 1/17 例，p=0.002）和更长的初始住院时间（18 天与 7 天，p=0.007）。
新诊断的泡型包虫病合并胆道梗阻患者可以单独使用苯并咪唑治疗有效治疗。另一方面，胆道介入治疗与高并发症发生率相关，可能应保留给对苯并咪唑治疗反应不足的患者。
