Hepatic Cystic Echinococcosis · Observe vs PAIR vs Surgery

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] WHO classification (activity) + size/complications
   WHO class (CE1-5)? Size/daughter cysts? Complications?
   • Active CE1/CE3a, simple cyst, puncturable → CE1/CE3a → PAIR
   • CE2/CE3b (multiple daughter cysts)/large/complications (biliary fistula/infection)/superficial → CE2/CE3b/large/complicated → surgery
   • Inactive CE4/CE5, asymptomatic → CE4/CE5 → observe
   • Rupture/anaphylactic shock/biliary obstruction → Rupture/obstruction → emergency
2. [End] CE4/CE5 → observe
   Inactive (CE4/CE5), asymptomatic → watch-and-wait + follow-up; no surgery needed.
3. [End] CE1/CE3a → PAIR
   Active CE1/CE3a, simple cyst → PAIR (puncture-aspiration-injection of a protoscolicidal agent-reaspiration) + perioperative albendazole; prevent biliary fistula and anaphylaxis (exclude biliary communication first).
4. [End] CE2/CE3b/large/complicated → surgery
   CE2/CE3b (multiple daughter cysts)/large/complicated/superficial → surgery (endocystectomy or partial/total pericystectomy) + perioperative albendazole; intraoperatively prevent cyst-fluid spillage with seeding and anaphylaxis.
5. [End] Rupture/obstruction → emergency
   Cyst rupture/anaphylactic shock/biliary obstruction → emergency management (anti-allergy/resuscitation, ERCP or surgery); strictly prevent intraoperative dissemination.

Source guidelines & references

• Hepatic cystic echinococcosis (WHO-IWGE classification and management; PAIR/surgery/albendazole)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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