title: A comparison of imaging guided double percutaneous aspiration injection and surgery in the treatment of cystic echinococcosis of liver.
abstract: OBJECTIVE
  To compare the results and complications of treatment by double percutaneous aspiration injection (DPAI) in cystic echinococcosis (CE) of the liver with those of surgery. To the best of our knowledge, such a study has not been carried out till date.
  
  
  METHODS
  From November 2012 to November 2015, 43 patients were randomly allocated to DPAI group (n = 22) and surgery group (n = 21). After the intervention, patients were evaluated monthly for 3 months, then at the sixth month and 6 monthly thereafter.
  
  
  RESULTS
  Average hospital stay was 2.38 days in DPAI group and 8.23 days in the surgery group. Response to DPAI was categorized as successful in 95.3% (n = 20) patients and incomplete in 4.7% (n = 1) patients. Response to surgery was characterized as successful in 85.7% (n = 18) patients and incomplete in 4.7% (n = 1) patients, and recurrence was seen in 9.5% (n = 2) patients. Using a 10% margin for non-inferiority, treatment response in the DPAI group was non-inferior to that of the surgery group. In the DPAI group, 19 patients had no complications, minor complications were seen in 4.7% (n = 1) patients and a major complication was seen in 4.7% (n = 1) patients. In the surgery group, no complications were seen in 13 patients, major complications were seen in 28.57% (n = 6) patients and minor complications were seen in 9.5% (n = 2) patients.
  
  
  CONCLUSIONS
  Over a follow-up period of 3 years, DPAI is non-inferior to surgery in the treatment of CE of the liver, while there is a statistically significant difference in the hospital stay and occurrence of complications. Advances in knowledge: DPAI offers advantages such as a short hospital stay, minimal invasiveness and morbidity, while being non-inferior to surgery. Total Immunoglobulin G antibody titres have limited utility in follow-up of patients treated.
authors.affiliation: 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India.
authors.forename: Tahleel A
authors.initials: TA
authors.lastname: Shera
authors.affiliation: 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India.
authors.forename: Naseer A
authors.initials: NA
authors.lastname: Choh
authors.affiliation: 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India.
authors.forename: Tariq A
authors.initials: TA
authors.lastname: Gojwari
authors.affiliation: 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India.
authors.forename: Faiz A
authors.initials: FA
authors.lastname: Shera
authors.affiliation: 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India.
authors.forename: Feroze A
authors.initials: FA
authors.lastname: Shaheen
authors.affiliation: 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India.
authors.forename: Ghulam M
authors.initials: GM
authors.lastname: Wani
authors.affiliation: 1 Department of Radiodiagnosis and Imaging, SKIMS, Srinagar, India.
authors.forename: Irfan
authors.initials: I
authors.lastname: Robbani
authors.affiliation: 2 Department of General Surgery, SKIMS, Srinagar, India.
authors.forename: Nisar A
authors.initials: NA
authors.lastname: Chowdri
authors.affiliation: 3 Department of Gastroentrology, SKIMS, Srinagar, India.
authors.forename: Altaf H
authors.initials: AH
authors.lastname: Shah
mesh_terms: D000328:Adult; D004444:Echinococcosis, Hepatic / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D007902:Length of Stay; D008099:Liver / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D013396:Suction; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional