Table 1

Evaluation and follow-up of vascular pathology in alveolar echinococcosis compensated advanced chronic liver disease (cACLD)—asymptomatic advanced fibrosis or cirrhosis

Infectious diseasesRadiologyGastroenterology
  • Start benzimidazole treatment with a low dose (albendazole 200 mg/day; mebendazole 500 mg/day) if suspected cACLD. Close monitoring for drug toxicity (liver function tests, full blood count, hair loss, drug levels). Stepwise (2–4 weeks) dose increase if feasible.

  • Monitor for development of cACLD by liver stiffness measurement with transient elastography (TE). Refer suspected cACLD patients (TE 10–15 kPa) to hepatologist for further workup.

  • Evaluate surgical treatment options to prevent long-term complications of vascular pathology even if R0 resection is not possible.

  • ‘One-stop-shop MRI’ including general non-contrast sequence protocols, dynamic contrast-enhanced imaging and MR cholangiography balanced steady-state free-precession sequence protocol.

  • Consider contrast-enhanced CT in case of hilar infiltration and/or hepatic artery involvement.

  • Use structured reporting for assessment of vascular and biliary involvement.

  • Imaging guides determination of R0 resectability

  • Monitor hepatic vasculature and IVC by colour-coded duplex ultrasonography at 3–6 months intervals.

  • IVC or PV obstruction

  • Evaluate for oesophageal varices— set follow-up intervals

    • No varices: screening at diagnosis and then yearly till 2 years after diagnosis.

    • ≥Grade I: yearly follow-up.

    • ≥Grade II

      • Primary prophylaxis of portal hypertension-related bleeding: NSBB for grade II and III varices.

      • Secondary prophylaxis of portal hypertension-related bleeding: NSBB and band ligation.

  • IVC or hepatic vein obstruction.

  • Evaluate for secondary Budd-Chiari-Syndrome.

  • Discuss indication for anticoagulation and weigh anticoagulation benefit against bleeding risk.

  • IVC, inferior vena cava; NSBB, non-selective beta-blocker; PV, portal vein.