John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Cystic echinococcosis of the liver Volume 28, issue 10, Décembre 2021


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1 CHRU Jean Minjoz, Laboratoire de Parasitologie-Mycologie, Centre National de Référence Échinococcoses, boulevard A. Fleming 25030 Besançon Cedex
2 CHRU Jean Minjoz, Service de chirurgie viscérale, digestive et cancérologique, Unité de transplantation hépatique, boulevard A. Fleming 25030 Besançon Cedex
3 Hôpitaux Universitaires de Genève, Services d’Hépato-Gastroentérologie et de Médecine Tropicale et Humanitaire, rue Gabrielle-Perret-Gentil, Genève, Suisse
4 CHRU Jean Minjoz, Service de radiologie viscérale, boulevard A. Fleming 25030 Besançon Cedex
5 Cabinet d’Hépato-Gastroentérologie, 7 rue Felix Eboue 13002 Marseille ; Consultant-expert pour le CNR Echinococcoses du CHU de Besançon
6 Polyclinique internationale Riad Annakhil Rabat Maroc, Service d’hépato-gastroentérologie, Membre du groupe WHO-IWGE (Groupe informel de travail de l’OMS sur la prise en charge de l’échinococcose kystique)
* Correspondance

Cystic echinococcosis (CE), a denomination now replacing that of hydatid cyst, is a cosmopolitan parasitic zoonosis. It is present mainly in countries where sheep farming constitutes an important resource explaining that in France, the majority of patients are migrants. Humans is an accidental intermediate host. The liver is the organ of choice for the development of the larval stage of Echinococcus granulosus (E. g) sensu lato. The progression of the cyst is extremely slow, comparable to that of a benign tumor. The clinical presentation is of great diversity, often completely asymptomatic and of fortuitous discovery but sometimes revealed by an acute clinical picture which can be life-threatening, related to complications. The most frequent one is the cyst rupture within the bile ducts. The diagnosis is based on the ultrasound examination using the WHO classification. It also allows to assess the evolutionary stage that is crucial to make treatment decisions. Depending on the situation, simple monitoring or a treatment combining, as the case may be, medication in the form of a parasitostatic, albendazole, instrumental techniques and surgery may be offered. The hepato-gastroenterologist is on the front line at each of these steps, at the end of which decisions benefit greatly from a multidisciplinary discussion. This also makes it possible to avoid over-treatment. Prospective studies are needed to progress on the therapeutic aspects which, to date, are essentially based on expert opinion. The French observatory of CE, OFREKYS, initiated in 2018 by the National Reference Center on Echinococcosis at Besançon University Hospital should contribute to better knowledge of this disease in our country.