Peroral cholangioscopy-guided diagnosis and treatment of Clonorchis sinensis liver flukes (original) (raw)

An 80-year-old man presented to our hospital with pain in the right upper quadrant of the abdomen that started 2 weeks prior to presentation. Laboratory analysis showed elevated C-reactive protein without leukocytosis. A transabdominal ultrasound showed dilated intrahepatic and extrahepatic bile ducts and gallbladder deposits. After obtaining informed consent, endoscopic ultrasonography (EUS) was pursued to explore the etiology for this biliary abnormality.

EUS revealed cholelithiasis, features suggestive of cholecystitis, and a dilated common bile duct (CBD) (Fig. 1 a, b). Endoscopic retrograde cholangiopancreatography with cholangioscopy was subsequently performed for further evaluation and management.

Fig. 1.

Fig. 1

Imaging studies and endoscopy.a, bEndoscopic ultrasonography showed cholecystolithiasis, cholecystitis, and a dilated common bile duct (CBD).cThe cholangioscope was introduced into the CBD and a_Clonorchis sinensis_body was visible.dThe opening of the cystic duct was directly observed under cholangioscopy.e _C. sinensis_parasites were visible through direct cholangioscopy into the intrahepatic bile duct.fThe_C. sinensis_body was removed using an elongated basket.

A cholangioscope was successfully introduced into the CBD and showed_Clonorchis sinensis_in the duct (Fig. 1 c). The opening of the cystic duct was clearly visualized under cholangioscopy (Fig. 1 d).C. sinensis_parasites were also noted in the intrahepatic bile duct. We were unable to clear the biliary tree of_C. sinensis_despite copious irrigation and suction using the cholangioscope (Fig. 1 e). The_C. sinensis_body was then captured by an elongated basket and removed under direct cholangioscopic view through the duodenal papilla, in an atraumatic fashion (Fig. 1 f,Video 1 ). Praziquantel was administered for 3 days after the procedure to treat_C. sinensis.

Peroral cholangioscopy-guided diagnosis and treatment of_Clonorchis sinensis_liver flukes.

Video 1

Clonorchiasis is a common biliary parasitic disease1. The diagnosis of clonorchiasis is generally made by identifying the parasite eggs in fecal samples. However, our patient had tested negative for_C. sinensis_in stool. Studies have shown that cholangioscopy can improve the diagnostic rate of biliary diseases while reducing the use of X-rays2 3 4. In the present study, cholangioscopy facilitated the diagnosis and retrieval of biliary parasites.

Endoscopy_UCTN_Code_CCL_1AZ_2AI

Acknowledgement

We express our gratitude to Dr. Faisal S. Ali, Gastroenterology, Hepatology, and Nutrition Department, University of Texas Health Science Center at Houston, Texas, USA, for his encouragement and assistance in revising the manuscript.

Footnotes

Conflict of Interest The authors declare that they have no conflict of interest.

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