title: Current management of cystic echinococcosis: a survey of specialist practice.
abstract: BACKGROUND
  Cystic echinococcosis (CE) is a significant public health problem worldwide. However, there remains a dearth of evidence guiding treatment in various stages of CE. The 2010 World Health Organization (WHO) Informal Working Group on Echinococcosis (WHO IWGE) guidance is thus based on expert consensus rather than a good evidence base. This study aims to describe the way clinicians worldwide manage CE and to establish whether clinicians follow WHO IWGE guidance.
  
  
  METHODS
  Using the online surveying tool SurveyMonkey, a questionnaire was produced detailing 5 clinical cases. Clinicians treating CE were identified and asked how to manage each case through tick-box and short-answer questions.
  
  
  RESULTS
  The results showed great variation in practice worldwide. There are practices in common use that are known to be ineffectual, including puncture, aspiration, injection, reaspiration procedures on WHO type 2 cysts, or outdated, including interrupted, rather than continuous, courses of albendazole. A number of unsafe practices were identified such as using scolicidal agents in cysts communicating with the biliary tree and short-course medical therapy for disseminated disease. Most clinicians do not follow the WHO IWGE guidance, but the reasons for this are unclear.
  
  
  CONCLUSIONS
  Management of CE varies greatly worldwide. There are key areas of CE for which there is no evidence on which to base guidelines, and randomized controlled trials are needed together with a well-designed international registry to collect data. Further work is required to establish why clinicians do not follow the IWGE guidance, together with better dissemination of future guidance.
authors.affiliation: The Hospital for Tropical Diseases.
authors.forename: Laura Eve
authors.initials: LE
authors.lastname: Nabarro
authors.affiliation: Department of Imaging, University College London Hospitals.
authors.forename: Zahir
authors.initials: Z
authors.lastname: Amin
authors.affiliation: The Hospital for Tropical Diseases London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Chiodini
mesh_terms: D000328:Adult; D000871:Anthelmintics / Q000627:therapeutic use*; D003625:Data Collection / Q000379:methods; D004358:Drug Therapy / Q000379:methods* / Q000592:standards*; D004443:Echinococcosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010820:Physicians; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000592:standards*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000871:Anthelmintics
keywords: WHO; current management; cystic echinococcosis; hydatid