Parasites and Biliary stones

Summary and conclusion ١٣٨
Parasites in the biliary tree can cause the syndrome commonly
referred to as ‘Oriental cholangiohepatitis’. Features of this syndrome
include helminthiasis, biliary stones formation, choledochal obstruction
and recurrent cholangitis.
There are different diagnostic tools none specific for the diagnosis of
biliary parasitic infestations except the demonstration of eggs in feces
and/or duodenal contents. ERCP is extremely helpful in defining changes
in the bile ducts as well as demonstrating the parasites directly, their
location and movements. Ultrasonography, CT, MRI can be used to
demonstrate the parasites, dilatation of the biliary tree due to biliary
obstruction caused by the parasites, the presence of stones,
cholangiocarcinoma, hepatoma, liver abscesses or cysts.Also
Eosinophilia is often present but insignificant.
The treatment of biliary parasites infection includes conservative
treatment, endoscopy and/or surgery. Conservative treatment consists of
antihelminthics. Previously, surgical treatment was necessary for the
management of biliary parasites and related stones. Nowadays,
endoscopic spincterotomy and extraction of the biliary parasites by ERCP
is a good alternative to surgery, and carries less morbidity and mortality
than the surgical approach. Surgery is still indicated in cases with acute or
chronic cholecystitis due to parasitic infestation and related stones.