Reply to Akbulut et al
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RESPONSE: LETTER TO THE EDITOR
Reply to Akbulut et al Laura Escolà-Vergé 1,2 & Itxarone Bilbao 3 & Fernando Salvador 1,2 Received: 9 June 2020 / Accepted: 14 June 2020 # 2020 The Society for Surgery of the Alimentary Tract
To the editor, We appreciate the interest Akbulut et al. have shown regarding our observational retrospective study on cystic echinococcosis (CE) 1. Their thorough revision has motivated the correction of two typographical errors (the range of patients’ age included in the study is from 18 to 92 years, and the number of immunocompromised patients with signs of viability in Table 3 is 10, not 1, being the percentage 33.3% correct), but we believe that the limited number of patients in our series precludes a high-quality multivariate analysis as they have suggested. The cysts of CE may be in an active, transitional, or inactive phase, and there are different classifications (WHOIWGE, Gharbi) that use ultrasound (US) images to determine the cyst phase. One limitation of our study is that the WHOIWGE classification was only available in 67% of ultrasound radiological reports of the liver cysts, mainly due to the absence of a multidisciplinary team to evaluate CE patients in the first years of the study period, and due to the fact that our hospital is a referral center for liver surgery and in many cases of CE that came from other hospitals the CT was the only image procedure performed before surgery. However, CT allowed us to identify calcification in some cysts, and it has been shown that CT has a very good correlation with US for cysts in stage CE5 2.
* Fernando Salvador [email protected] 1
Infectious Diseases Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
2
Infectious Diseases Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
3
Hepatopancreatobiliary Surgery and Transplants Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
CE is one of the neglected tropical diseases recognized by the WHO, and its management guidelines are almost based on observational data and expert’s opinions. In general, inactive cysts only require radiological follow-up, and active or transitional cysts may need a more aggressive approach. In this sense, we aimed to evaluate if a positive serology or the presence of calcification could be helpful to predict cyst activity or inactivity, respectively, and with our limited number of patients, we could not find any significant result. Akbulut et al. have performed a sensitivity analysis in our data with similar results, but larger studies are needed to evaluate this matter. In fact, treatment should be individualized according to patient’s and cyst’s characteristics; for example, inactive cysts exerting or at risk of exerting pressure on adjac
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