Endoscopic retrograde cholangiopancreatography for biliary system parasites

Özet

Objective: Endoscopic retrograde cholangiopancreatography may be useful in the diagnosis and management ofbiliary system parasites.Material and Methods: Investigators retrospectively evaluated patients with biliary system parasites who underwentendoscopic retrograde cholangiopancreatography procedures over an eight-year period. We collected data regarding patient demographics, clinical features, and parasite type. We aimed to determine the utility of endoscopicretrograde cholangiopancreatography as a diagnostic and therapeutic intervention in patients with biliary systemparasites.Results: We identified 22 patients with biliary system parasites from a total of 3,450 endoscopic retrograde cholangiopancreatography procedures performed during an eight-year period. Parasite types included Echinococcus granulosus (n=19), Fasciola hepatica (n=2), and Ascaris lumbricoides (n=1). Fifteen patients with liver hydatid cysts underwent endoscopic retrograde cholangiopancreatography prior to surgery due to obstructive jaundice. The endoscopicretrograde cholangiopancreatography procedure enabled definitive treatment without the need for surgery in theremaining two patients. Two patients with fascioliasis underwent endoscopic retrograde cholangiopancreatographydue to clinical presentation of cholangitis, cholecystitis, and obstructive jaundice, leading to presumptive diagnosisof cholangiocarcinoma. However, the final diagnosis was made using endoscopic retrograde cholangiopancreatography following inspection of flat, leaf-shaped, motile flukes extracted from the bile duct. In one patient withascariasis, a longitudinal tubular structure was identified in the bile duct; emergency surgery was required.Conclusion: The diagnosis of parasitic diseases is clinically challenging, and definitive diagnosis requires endoscopicretrograde cholangiopancreatography in some cases. Moreover, endoscopic retrograde cholangiopancreatographyprovides a therapeutic option for ascariasis, fascioliasis, and some forms of hydatidosis. Accordingly, the use ofendoscopic retrograde cholangiopancreatography may change preoperative management and treatment strategiesfor biliary system parasite infections.