Application of the improved SELECT concept in the diagnosis and treatment of hepatic echinococcosis

Abstract Background: Hepatic echinococcosis is a zoonotic parasitic disease caused by the larvae of the tapeworm Echinococcus granulosus . It is prevalent in high-altitude pastoral regions such as Qinghai, China, posing a serious threat to the health of local residents. Due to its insidious early symptoms, many patients present at an advanced stage, with lesions often invading critical vascular structures. This results in significant treatment challenges and a high incidence of post-operative complications. The traditional single-modality diagnostic and therapeutic approach faces challenges, necessitating an integrated strategy to optimise the clinical pathway. Objective: This article aims to systematically elaborate on the enhanced SELECT concept based on multi-endoscopic technology. By comparing it with conventional approaches, this study evaluates its clinical value in the one-stop precision diagnosis and treatment of hepatic echinococcosis. Methods: This study is a comprehensive literature review and conceptual exposition. Systematic searches were conducted in databases, including PubMed, Web of Science, China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform. Search terms encompassed ‘hepatic echinococcosis’, ‘combined endoscopic techniques’, ‘SELECT concept’, ‘Spyglass (digital single-operator cholangioscopy system)’, ‘endoscopic retrograde cholangiopancreatography, ERCP,’ ‘laparoscopic hepatectomy’, ‘endoscopic ultrasound, EUS,’ ‘choledochoscopy’ and ‘autologous liver transplantation’. The time span covered the period from database inception to June 2025. In addition, drawing on the extensive surgical experience documented in the literature, this review summarises and analyses the technical essentials, indications and unique advantages of each component of the SELECT approach in the diagnosis and treatment of hepatic echinococcosis. Results: The improved SELECT concept integrates multiple endoscopic and surgical techniques to achieve precise pre-operative assessment, intra-operative manipulation and minimally invasive management of post-operative complications for hepatic echinococcosis, particularly in complex cases. This model optimises the diagnostic and therapeutic process through a one-stop service, potentially reducing post-operative recurrence rates and complications while conserving medical resources. Recent basic research (such as the effects of Thymbra spicata L. essential oil) has also provided new perspectives for adjunctive therapies in echinococcosis. Conclusion: The improved SELECT diagnostic and treatment model utilising multiple imaging modalities represents an effective strategy for managing complex hepatic echinococcosis, particularly in the high-burden regions with relatively scarce medical resources. Future research should further validate its long-term efficacy through prospective clinical studies and explore its combination with traditional medications and novel therapeutic agents.