PAIR (puncture-aspiration-injection-reaspiration)

The PAIR (puncture-aspiration-injection-reaspiration; sometimes percutaneous aspiration-injection-reaspiration{{Cite journal|last1=Smego|first1=Raymond A.|last2=Bhatti|first2=Sabha|last3=Khaliq|first3=Amir A.|last4=Beg|first4=M. Asim|date=2003-10-15|title=Percutaneous Aspiration-Injection-Reaspiration Drainage Plus Albendazole or Mebendazole for Hepatic Cystic Echinococcosis: A Meta-analysis|journal=Clinical Infectious Diseases|language=en|volume=37|issue=8|pages=1073–1083|doi=10.1086/378275|pmid=14523772|issn=1058-4838|doi-access=free}}) procedure is a noninvasive treatment option to remove hydatid cysts.{{cite journal|last=Filice|first=C|author2=Pirola, F |author3=Brunetti, E |author4=Dughetti, S |author5=Strosselli, M |author6= Foglieni, CS |title=A new therapeutic approach for hydatid liver cysts. Aspiration and alcohol injection under sonographic guidance.|journal=Gastroenterology|date=May 1990|volume=98|issue=5 Pt 1|pages=1366–8|pmid=2182372|doi=10.1016/0016-5085(90)90358-8}} PAIR is considered an alternative treatment for cystic echinococcosis (hydatid disease) and is often indicated for patients who do not respond to surgery or benzimidazoles{{cite journal|last=Brunetti|first=E|author2=Kern, P |author3=Vuitton, DA |author4= Writing Panel for the, WHO-IWGE |title=Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans.|journal=Acta Tropica|date=Apr 2010|volume=114|issue=1|pages=1–16|pmid=19931502 |doi=10.1016/j.actatropica.2009.11.001|doi-access=free}}

The PAIR procedure can be performed as follows:{{cite journal|last=Golemanov|first=B.|author2=Grigorov, N. |author3=Mitova, R. |author4=Genov, J. |author5=Vuchev, D. |author6=Tamarozzi, F. |author7= Brunetti, E. |title=Efficacy and Safety of PAIR for Cystic Echinococcosis: Experience on a Large Series of Patients from Bulgaria|journal=American Journal of Tropical Medicine and Hygiene|date=6 January 2011|volume=84|issue=1|pages=48–51|doi=10.4269/ajtmh.2011.10-0312|pmid=21212200|pmc=3005516}}

1. ultrasound-guided percutaneous puncture of the cyst
2. aspiration of cystic fluid
3. injection of a scolicidal solution
4. reaspiration of the solution