Parasites and Biliary stones

Introduction ٢
Clonorchis sinensis, and Fasciola hepatica, and the cestodes
Echinococcus granulosus and multilocularis (Carpenter, 1998).
Hence, we can see that parasitosis especially fascioliasis should be
considered in the diagnosis of cholestasis in Fasciola endemic areas
(Elshazly et al., 2005). Generally speaking ,in cases of
choledocholithiasis and extrahepatic jaundice, biliary tree parasitosis
must be considered in the differential diagnosis (Machado et al., 1996).
Management of biliary parasites begins with conservative measures,
including analgesics and anti-helminthic therapy. In refractory cases or
patients with acute cholangitis, endoscopic biliary drainage and the
extraction of worms may be necessary. Improvement in sanitation plays a
crucial role in the epidemiological control of these biliary diseases
(Leung and Yu, 1997).
ERCP was introduced in the early 1970s and has become the
diagnostic and therapeutic tool of choice in patients with
choledocholithiasis. The CBD is cannulated through the ampulla, contrast
material is injected, and films are obtained. The experience of the
endoscopist is the best predictor of success, which is 90-95% in expert
hands. In most patients, ERCP is the modality of choice when
choledocholithiasis is suggested (Dandan et al., 2005). ERCP
management in biliary parasitosis include multiple procedures such as
sphincterotomy , balloon dilatation of the sphincter of Oddi, forceps and
dormia basket extraction of the parasite (Gavindamasy and Thomsom,
2004).