ERCP IN BILIARY PARASITOSIS – FROM DIAGNOSIS TO TREATMENT

Description:

We present the video of 4 patients with biliary parasitosis, diagnosed and treated by endoscopic retrograde cholangiopancreatography (ERCP), in a series of more than 3000 CPREs performed in a gastroenterology department (prevalence < 0.14%).

Three of the cases correspond to biliary tree colonization by Fasciola hepatica, and the forms of presentation were recurrent anicteric cholestasis, biliary pancreatitis and obstructive jaundice respectively. In 2 patients, the parasite was removed from the bile duct still alive. Endoscopic treatment was complemented with triclabendazole.

The last case corresponds to a patient with cholangitis. During ERCP, cholangiography showed a long linear opacity suggestive of Ascaris lumbricoides (AL) in the biliary tract. After performing the sphincterotomy, the bile duct was explored with a Dormia basket and a balloon extractor, removing multiple AL already without motility. Endoscopic treatment was supplemented with albendazole.

Motivation:

In Portugal, as in other developed countries, biliary parasitosis are rare diseases. However, the incidence of these infestations appears to be increasing in line with the increase in tourism and immigration. The diagnosis of parasites in the biliary tree is usually performed by ultrasound, computorized tomography, magnetic resonance imaging or even echoendoscopy. ERCP, an essentially therapeutic technique, is used for the removal of these parasites from the bile duct. There are, however, very rare cases in which the diagnosis is made only during ERCP.

With this video we intend to illustrate the typical findings of these parasitosis, in cholangiography and duodenoscopy, as well as to demonstrate the usefulness of this technique in the treatment of biliary obstructions by this etiology.