Percutaneous aspiration in the treatment of hydatid liver cysts.

EDITOR,-During a survey of recent literature in preparation for the XVII International Congress on Hydatidology (held in Limassol, Cyprus, 6-10 November 1995) we have read with interest the article by Morris about liver echinoccosis (Gut 1994, 35: 1517-8). We have, however, been somewhat surprised by his misquoting of our paper.' The two lines devoted to percutaneous aspiration ('The risks of fluid leakage are high and anaphylaxis has been well reported') are not representative of what we meant. We suggested exactly the opposite that is, the risks of fluid leakage and anaphylaxis, although real, seem rather overestimated. No such side effects were reported in our by then rather small series, nor by the authors who inadvertently or not had at that time aspirated a hydatid cysts.2 3 No major side effect was registered by the other groups who, at the time Morris wrote his paper, had diagnosed or treated by percutaneous aspiration more than 100 hydatid cysts and published the results of their work.4" We feel even more entitled to say this five years after, when our series has grown to 163 patients with 231 cysts treated this way'2 and a growing number of colleagues' reports of patients treated by this or similar methods.'3 The series reported in those latest papers represent an overall population of more than 1000 patients treated with percutaneous puncture, and not in a single case anaphylactic shock or peritoneal dissemination have been reported. Both we and some of the mentioned authors reported only mild allergic reactions. Indeed, the probability of major problems such as fluid leakage and anaphylaxis (obviously when the procedure is performed by experienced personnel, and once the correct prophylaxis with mebendazole or albendazole has been set) is so low that the World Health Organisation recently recognised the procedure as a first choice method for treatment of hydatidosis especially in developing countries. As regards Western countries, we feel that PAIR (puncture, aspiration, injection, reaspiration) has gained a status such as to be proposed as an alternative treatment to surgery (when the patients cannot or do not want to undergo surgery). Its main advantages are greater safety, less expense, less distress for the patients. We would therefore like to suggest that Dr Morris is more explicit in his next reviews concerning treatrnent of liver hydatidosis.