Efficacy and Safety of PAIR for Cystic Echinococcosis Experience on a Large Series of Patients from Bulgaria

We report our experience with puncture, aspiration, injection and reaspiration (PAIR) for the treatment of cystic echinococcosis in Bulgaria PAIR was performed in 230 patients with 348 echinococcal cysts At 12-month follow up, 77 6% of the cysts, all cystic echinococcosis (CE) 1 and CE3a cysts according to the World Health Organization Informal Working Group classification, showed various degrees of obliteration In 11 5% of cysts, all of which were > 10 cm-type CE1, a significant amount of fluid persisted, and they were punctured again Of those 16 (4 6%) contained protoscolices and were treated by a second PAIR The remaining 24 (6 9%) cysts were treated by simple aspiration or drainage No significant reduction in size and no changes in the structure were observed in 10 9% of cysts, all of which were classified as CE2 or CE3b Complications developed in 25 2% of patients, including severe anaphylactic reaction in two (0 9%) patients Our experience confirms that PAIR is a successful first choice treatment when a stage specific approach is taken