Endoscopic diagnosis and treatment of biliary obstruction due to acute cholangitis and acute pancreatitis secondary to Fasciola hepatica infection

In the differential diagnosis of biliary obstruction with unknown etiology, biliary fascioliasis should be considered in endemic and non-endemic regions. After diagnostic evaluation, endoscopic retrograde cholangiopancreatography (ERCP) was performed for etiological evaluation and/or treatment of biliary obstruction in five patients with a mean age of 55.8 years. Endoscopic sphincterotomy and cholangiogram revealed linear filling defects in the biliary system. Fasciola hepatica parasites were extracted using balloon and basket catheters in two and three patients, respectively. No morbidity or mortality was observed. F. hepatica infection should be considered as a differential diagnosis of biliary obstruction with unknown etiology in endemic and non-endemic regions. ERCP can be the standard diagnostic and/or therapeutic procedure in cases of biliary obstruction due to fascioliasis. Due to slippery and gel-like characteristics of the parasite, use of a basket catheter in semi-opened position may be required in case of unsuccessful extraction using a balloon catheter.

Fasciola hepatica’ya ikincil akut kolanjit ve akut pankreatitin yol açtýðý biliyer obstrüksiyonun endoskopik taný ve tedavisi

Biliyer Fasciola hepatica enfestasyonu, endemik ve non-endemik bölgelerde etiyolojisi bilinmeyen biliyer týkanýklýðýn ayýrýcý tanýsýnda olasý bir sebep olarak düþünülmelidir. Tanýsal deðerlendirme sonrasý safra yollarýnda obstrüksiyon saptanan ortalama yaþlarý 55.8 yýl olan beþ hastaya etiyolojik deðerlendirme ve/veya endoskopik tedavi için endoskopik retrograd kolanjiyopankreatografi uygulandý. Endoskopik sfinkterotomi ve kolanjiyogram, biliyer sistemde safra dolum defektlerini gösterdi. Balon ve sepet kateteri kullanýlarak sýrasýyla iki ve üç hastada Fasciola hepatica parazitleri çýkartýldý. Morbidite veya mortalite görülmedi. Fiziksel ve laboratuvar bulgular 10 gün içinde kademeli azalarak normalleþti. Fasciola hepatica, endemik ve non-endemik bölgelerde etiyolojisi bilinmeyen safra yolu týkanýklýðý ayýrýcý tanýsýnda öncelikle düþünülmelidir. Fasciola hepatica’ya baðlý safra yolu týkanýklýðý olgularýnda endoskopik retrograd kolanjiyopankreatografi standart taný ve/veya tedavi yöntemidir. Parazitin kaygan ve jel benzeri yapýsýndan dolayý, balon kateterin yetersiz kaldýðý durumlarda, yarý-açýk pozisyonda sepet kateterin kullanýlmasý gerekebilir.