Peroral cholangioscopy-guided diagnosis and treatment of Clonorchis sinensis liver flukes

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 Imaging studies and endoscopy. a, b Endoscopic ultrasonography showed cholecystolithiasis, cholecystitis, and a dilated common bile duct (CBD). c The cholangioscope was introduced into the CBD and a Clonorchis sinensis body was visible. d The opening of the cystic duct was directly observed under cholangioscopy. e C. sinensis parasites were visible through direct cholangioscopy into the intrahepatic bile duct. f The 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.

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Peroral cholangioscopy-guided diagnosis and treatment of Clonorchis sinensis liver flukes.Video 1

Clonorchiasis is a common biliary parasitic disease [1]. 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-rays [2] [3] [4]. In the present study, cholangioscopy facilitated the diagnosis and retrieval of biliary parasites.

Endoscopy_UCTN_Code_CCL_1AZ_2AI

Conflict of Interest

The authors declare that they have no conflict of interest.

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.

• References

• 1 Li X, Wang JC, Guan L. et al. Advances in the pathogenesis of cholangiocarcinoma caused by Clonorchis sinensis. Chin J Parasitol Parasit Dis 2020; 38: 250-254
• 2 Dumonceau JM, Kapral C, Aabakken L. et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 127-149
• 3 Tao LY, Wang HG, Guo QM. Single-operator cholangioscopy system for management of acute cholecystitis secondary to choledocholithiasis. Endosc Int Open 2023; 11: E1138-E1142
• 4 Chinese Society of Digestive Endoscopy. Chinese expert consensus on peroral biliary-pancreaticoscopy super minimally invasive technique (2023, Beijing). Chin J Gastrointest Endosc 2023; 10: 217-241

Publication History

Article published online:
07 June 2024