Parasites and Biliary stones

Billiary parasites ٦
Treatment:
Figure (1): 2 worms in the major papilla (Courtesy of Dr. Tarik Zaher)
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 (Khuroo et al., 1987).
Nowadays, endoscopic sphincterotomy and extraction of the biliary
parasites 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 (Schulman et al., 1982).
Biliary parasites causing recurrent pyogenic cholangitis due to
biliary tree invasion and obstruction which is treated endoscopically by
sphincterotomy, parasite extraction and nasobiliary drainage. The
nasobiliary tube is also used for instillation of antihelminthics (Cremin,
1982). ERCP is helpful during the active phase and sometimes worms
may be seen moving actively into the biliary tree from the duodenum
(Jessen et al., 1986).