Update on Treatment for Cystic Echinococcosis of the Liver

Cystic echinococcosis (CE) is a chronic, complex, and neglected disease. Its treatment depends on a number of factors, such as location, size, and stage of the cysts, and availability of therapeutic options. Despite the wealth of scientific literature on treatment for echinococcosis, the current management of the disease is based on poor to moderate quality of evidence and recommendation strength. In addition, therapeutic strategies have been developed over time without systematic and adequate evaluation of their efficacy, effectiveness, and safety. This is due to the lack of large, longitudinal, controlled studies, which in turn is partly due to the chronicity of the disease which requires a follow-up of many years. The lack of adequate funding makes these costly trials impossible to implement. Although the recommended multidisciplinary and stage-specific approach may be available in referral centers, this is often not the case in many endemic countries, where the most affected populations have limited access to diagnosis and therapy, and where the risks associated with invasive procedures may be particularly high. The level of evidence on which clinicians have to rely is low. For the time being, patients should preferably be treated in referral centers only. Proper comparative clinical trials are urgently needed. Because of space constraints, this update will focus on the most frequent location of CE, the liver.