Chairman : C. Filice (Italy)

During the XVIII World Congress of Hydatidology, a Round Table was organized by WHO-IWGE on the issue of PAIR - Long term follow-up. The presidents were Peter Schantz and Carlo Filice. By the end of 1996, the WHO-IWGE launched a survey on the current status of PAIR; a number of doctors known to be active in this field were contacted with a letter jointly signed by Prof. DA Vuitton and by Prof. C.Filice, requesting them to fill forms with data from patients treated with PAIR.

The Round table followed a number of interventions describing the current status of PAIR in the main areas interested by Echinococcosis

Enrico Brunetti from Pavia, Italy introduced the session;

Calum Mc Pherson (Grenada) proposed a new international classification of US images in cystic echinoccosis.

Experience with PAIR in Europe and Africa was reported by Enrico Brunetti and Eberhard Zeyhle;in Asia it was reported by Wen Hao (China);

in the Middle east and Central Asian Countries by Okhan Akhan (Turkey)

in America by Victor Pelaez

A total of 765 cysts (in table A) were collected for this round table, including 465 already published in various medical journals.

Table A

Table B

Table C

* Not included in the total count of cases ( Table A )because technically different from PAIR.

** Not included in the total count of cases ( Table A ) ( data about cases not available ).

The data shown at this session are of great interest, showing that:

1 ) The use of PAIR is widespread and increasing in all areas where CHD is a problem.

2) These data show PAIR to be a safe and effective therapeutic tool

3) The risk of anaphylaxis during PAIR has been greatly overrated

4) Accuracy of follow-up may be a problem in poorer areas (e.g where the population is nomadic), but so far no case of peritoneal dissemination after PAIR has been reported. As of today over 70 cases with a follow up > 5 years with no evidence of peritoneal dissemination are available; although obviously longer times of observation are needed, it seems like the risk of peritoneal dissemination after PAIR may have been a little overestimated.

5) There is need to continue studies about PAIR.

A main issue is to standardize at least a minimal number of points of the various PAIR protocols under WHO supervision in order to compare their efficacy and to set up prospective studies.

The key points of the discussion are listed below :

• Eligibility for procedure (patients and cyst type)
• Prophylaxis pre & post procedure ERCP (Western Countries)
• Electrolytes in the fluid
• Evaluation of viability
• Bile in the fluid
• Needle vs catheter
• Quantity to be injected
• Cystography (Western Countries)
• Follow-up
• Other

During the following meeting of Informal Working Group the idea of publishing Guidelines for PAIR, in order to make possible large prospective studies, was emitted by Prof. Vuitton.

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