# A case report of definitive endoscopic management of a large right liver lobe hydatid cyst - A novel approach

## TL;DR

This case report describes a successful endoscopic treatment for a large liver hydatid cyst, offering a less invasive option for managing this endemic disease.

## Contribution

The paper presents a novel endoscopic approach using cautery-enhanced stents for definitive management of hydatid cysts.

## Key findings

- A large right lobe hydatid cyst was successfully treated with endoscopic drainage and no recurrence was observed.
- The use of cautery-enhanced lumen apposing metal stents provided a low-morbidity alternative to surgery.
- This approach highlights the expanding role of endoscopic ultrasound in managing complex liver cysts.

## Abstract

Cystic echinococcosis is a public health concern worldwide and is endemic in rural communities in South Africa (Shaw et al., 2006). The management of hydatid liver disease is of vital socio-economic importance within the infected communities (Centers for Disease Control and Prevention [Internet]. Echinococcosis). Often, surgical intervention is needed, and this carries its own morbidity and economic burden in our low-to-middle income setting (Acta Trop., 2003). Definitive endoscopic management is rarely considered and offers an exciting option with decreased morbidity to the patient.

This is a case report of a 36-year-old male who presented with a large right lobe liver hydatid cyst causing abdominal discomfort and pain. He also described early satiety and weight loss with malaise. The symptoms had been present for approximately 8-months duration. The diagnosis of a hydatid liver cyst was made on positive serology and imaging (CE1). The disease was managed with medical treatment using a full course of albendazole initially and then endoscopic drainage into the duodenum using a cautery-enhanced lumen apposing metal stent. There has been no recurrence up to the present time and complete symptom and cyst resolution has been noted.

Given the success of this unconventional management, this case report will help in providing a low-morbidity management option in this endemic disease in certain selected cases. It also provides in detail how to use this option as a definitive management pathway.

This management option required dynamic thinking and a new application of a revolutionary technology which has changed endoscopic management of a variety of conditions.

•Echinococcus granulosus is an endemic disease in rural South Africa as well as many other parts of the world.•Complications are seen in up to one third of patients with hydatid liver disease•A large, symptomatic hydatid cyst was managed definitively using endoscopic internal drainage.•This is an innovation of the growing role of endoscopic ultrasound and cautery-enhanced lumen apposing metal stents.

Echinococcus granulosus is an endemic disease in rural South Africa as well as many other parts of the world.

Complications are seen in up to one third of patients with hydatid liver disease

A large, symptomatic hydatid cyst was managed definitively using endoscopic internal drainage.

This is an innovation of the growing role of endoscopic ultrasound and cautery-enhanced lumen apposing metal stents.