VideoGIE| Volume 84, ISSUE 3, P528, September 2016

Endoscopic diagnosis of gastric anisakiasis and extraction of larvae

Published:April 07, 2016DOI:
      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 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 thumbnail gr1
      Figure 1Anisakis larva attached to the gastric mucosa.
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        Gastrointestinal EndoscopyVol. 86Issue 1
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          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.
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