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A recent case of gastric anisakiasis was encountered at our institute. Anisakiasis
is a human parasitic disease that occurs when patients ingest fish contaminated with
the parasite. The third-stage larva of the parasite burrows into the mucosa (Fig. 1), causing symptoms that include abdominal pain, nausea, vomiting, and, rarely, large
gastric tumors and local lymphadenopathy. The diagnosis is made in gastroscopy where
the larva is encountered. The treatment is to remove the larva intact from the site
of mucosal attachment, leading to prompt symptom resolution (Video 1, available online at www.giejournal.org). Incomplete removal can lead to progressive granuloma and fibrosis, causing chronic
symptoms. There are reports of chronic anisakiasis provoking gastric ulcers, and recently
it has been recognized as a causative factor for human cancer. Grasping the larva
closer to the anchoring site ensures intact removal. Antihelminthic treatment is not
indicated after the removal of the larva, and follow-up gastroscopy is not indicated,
given the lack of sequelae after the removal of the parasite. Because of the increasing
popularity of raw fish consumption, it is important for gastroenterologists to be
aware of this diagnosis. Given the simplicity of the treatment, this disease should
be considered in the differential diagnosis of patients presenting with suggestive
symptomatology.
Figure 1Anisakis larva attached to the gastric mucosa.
We thank Dr Ustundag and Dr Saritas1 for their interest in our work. Our study was designed with 4 groups, including normal saline solution (NS) with placebo, NS with indomethacin (IND), lactated Ringer’s solution (LR) with placebo, and LR with IND.2 If additional intravenous fluids (IVF) were required, as in the case of pancreatitis, additional IVF type was based on study group assignment. Our primary objective was to evaluate the difference in post-ERCP pancreatitis (PEP) and readmission between the NS with placebo and the LR with IND groups; our study was powered for this comparison only.
