Endoscopic retrograde cholangiopancreatography for biliary system parasites
Sezgin Yılmaz1, Murat Akıcı1, Merih Şimşek2, Nazan Okur3, Ogün Erşen1, Ahmet Ali Tuncer4
1Department of General Surgery, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
2Department of Microbiology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
3Clinic of Radiology, Afyon State Hospital, Afyonkarahisar, Turkey
4Department of Pediatric Surgery, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
Objective: Endoscopic retrograde cholangiopancreatography may be useful in the diagnosis and management of biliary system parasites.
Material and Methods: Investigators retrospectively evaluated patients with biliary system parasites who underwent endoscopic 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 endoscopic retrograde cholangiopancreatography as a diagnostic and therapeutic intervention in patients with biliary system parasites.
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 endoscopic retrograde cholangiopancreatography procedure enabled definitive treatment without the need for surgery in the remaining two patients. Two patients with fascioliasis underwent endoscopic retrograde cholangiopancreatography due to clinical presentation of cholangitis, cholecystitis, and obstructive jaundice, leading to presumptive diagnosis of 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 with ascariasis, 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 endoscopic retrograde cholangiopancreatography in some cases. Moreover, endoscopic retrograde cholangiopancreatography provides a therapeutic option for ascariasis, fascioliasis, and some forms of hydatidosis. Accordingly, the use of endoscopic retrograde cholangiopancreatography may change preoperative management and treatment strategies for biliary system parasite infections.
Keywords: Echinococcosis, endoscopic retrograde cholangiopancreatography, Fasciola hepatica, biliary system
Cite this paper as: Yılmaz S, Akıcı M, Şimşek M, Okur N, Erşen O, Tuncer AA. Endoscopic retrograde cholangiopancreatography for biliary system parasites. Turk J Surg 2018; 34(4): 306-310.
Ethics committee approval was received for this study from the ethics committee of of Afyon Kocatepe University.
Written informed consent was obtained from patients who participated in this study.
Concept - S.Y., M.A., A.A.T., O.E.; Design - S.Y., M.A., M.Ş.; Supervision - S.Y., M.A., A.A.T., N.O.; Resource - S.Y., M.A., M.Ş. N.O.; Materials - O.E., M.A., M.Ş.; Data Collection and/or Processing - N.O., S.Y., O.E.; Analysis and/or Interpretation - M.A., S.Y., O.E.; Literature Search - A.A.T., N.O., S.Y.; Writing Manuscript - A.A.T., M.A., S.Y.; Critical Reviews - A.A.T., M.A., S.Y., O.E., N.O., M.Ş.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.