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Endoscopic diagnosis and management of biliary parasitosis

D Nageshwar Reddy, MD
Amitabh Monga, MBBS, MD, MRCP (UK), FAMS
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Parasitic infections of the biliary tract are a major concern in the tropical and subtropical countries with significant morbidity and mortality. Clinicians in other parts of the world should also be aware of these infections in view of increasing travel and migration.

Infestations of the hepatic and extrahepatic biliary tree occur most commonly with Ascaris lumbricoides, Clonorchis sinensis, Opisthorchis felineus, and Fasciola hepatica. Other hepatobiliary parasites include Opisthorchis viverrini, Fasciola gigantica, and Dicrocoelium dendriticum.

Helminthic infestation affects the liver and the biliary tract either during transit of worms or because these organs serve as natural habitats. Worms in the bile ducts may produce features of recurrent pyogenic cholangitis or acute pancreatitis [1,2], liver cysts and abscesses may occur due to ascariasis or liver flukes [3], and hepatic Echinococcal cysts can rupture into the biliary tract, producing cholangitis. Endoscopic retrograde cholangiopancreatography has now become the main diagnostic and therapeutic tool in these patients.

This topic will review the endoscopic diagnosis and management of biliary parasitosis. Detailed discussions of the various parasites and a discussion of recurrent pyogenic cholangitis can be found elsewhere. (See "Ascariasis" and "Epidemiology and control of echinococcosis" and "Treatment of echinococcosis" and "Liver flukes: Clonorchis, Opisthorchis, and Metorchis" and "Liver flukes: Fascioliasis" and "Recurrent pyogenic cholangitis".)


The roundworm, A. lumbricoides, is globally one of the most highly prevalent helminthic parasites in humans, infecting an estimated one billion people (see "Ascariasis"). Fortunately, it only infrequently produces symptomatic disease. A. lumbricoides organisms normally reside in the jejunum but are actively motile and can invade the papilla, thus migrating into the bile duct and causing biliary obstruction with a variety of hepatobiliary complications. The following disease associations were observed in a series from Kashmir, India of 500 patients with hepatobiliary and pancreatic disease due to Ascaris [4]:

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Literature review current through: Nov 2017. | This topic last updated: Aug 17, 2015.
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