Advertisement

Liver flukes diagnosed by ERCP in a local immigrant community

Published:August 03, 2022DOI:https://doi.org/10.1016/j.gie.2022.07.028

      Background and Aims

      Although a common pathogen in much of Asia, liver flukes are believed to be a rare cause of disease in the United States. In this series, we describe 3 patients diagnosed with Clonorchis sinensis during ERCP within 1 year at our institution.

      Methods

      Three patients referred to a large community hospital underwent ERCP with direct visualization of a worm in the biliary tree and subsequent histopathologic confirmation.

      Results

      The patients had variable clinical presentations, and 2 had repeat negative stool studies for ova and parasites. Each patient had imaging studies showing abnormalities within the biliary tree, after which ERCP was performed with direct visualization and extraction of a wormlike structure. It was confirmed that all 3 patients had emigrated from China within the last decade. The epidemiologic data and the histopathologic characteristics of the fluke eggs in utero were consistent with a diagnosis of C sinensis.

      Conclusions

      The diagnosis of clonorchiasis should remain on the differential diagnosis for patients with nonspecific biliary symptoms who have known risk factors for this uncommonly common pathogen.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kaewpitoon N.
        • Kaewpitoon S.-J.
        • Pengsaa P.
        Opisthorchiasis in Thailand: review and current status.
        World J Gastroenterol. 2008; 14: 2297-2302
        • Lim J.H.
        Liver flukes: the malady neglected.
        Korean J Radiol. 2011; 12: 269-279
        • Na B.-K.
        • Pak J.H.
        • Hong S.-J.
        Clonorchis sinensis and clonorchiasis.
        Acta Trop. 2020; 203105309
        • Pakharukova M.Y.
        • Mordvinov V.A.
        The liver fluke Opisthorchis felineus: biology, epidemiology and carcinogenic potential.
        Trans R Soc Trop Med Hyg. 2016; 110: 28-36
        • Qian M.-B.
        • Chen Y.-D.
        • Liang S.
        • et al.
        The global epidemiology of clonorchiasis and its relation with cholangiocarcinoma.
        Infect Dis Poverty. 2012; 1: 4
        • Suwannatrai A.
        • Saichua P.
        • Haswell M.
        Epidemiology of Opisthorchis viverrini infection.
        Adv Parasitol. 2018; 101: 41-67
        • Stauffer W.M.
        • Sellman J.S.
        • Walker P.F.
        Biliary liver flukes (opisthorchiasis and clonorchiasis) in immigrants in the United States: often subtle and diagnosed years after arrival.
        J Travel Med. 2004; 11: 157-159
        • Pfeifer C.M.
        • Bourm K.S.
        • Brandt M.R.
        • et al.
        Liver fluke-induced choledocholithiasis with biliary ductal obstruction.
        Radiol Case Rep. 2019; 14: 1483-1486
        • Qian M.-B.
        • Utzinger J.
        • Keiser J.
        • et al.
        Clonorchiasis. Lancet. 2016; 387: 800-810
        • Doanh P.N.
        • Nawa Y.
        Clonorchis sinensis and Opisthorchis spp in Vietnam: current status and prospects.
        Trans R Soc Trop Med Hyg. 2016; 110: 13-20
        • Marcos L.A.
        • Terashima A.
        • Gotuzzo E.
        Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis.
        Curr Opin Infect Dis. 2008; 21: 523-530
        • Ash L.
        • Orihel T.
        Ash & Orihel’s atlas of human parasitology.
        5th ed. ASCP Press, Chicago, IL2007
        • Marti H.
        • Koella J.C.
        Multiple stool examinations for ova and parasites and rate of false-negative results.
        J Clin Microbiol. 1993; 31: 3044-3045
        • Chan H.-H.
        • Lai K.-H.
        • Lo G.-H.
        • et al.
        The clinical and cholangiographic picture of hepatic clonorchiasis.
        J Clin Gastroenterol. 2002; 34: 183-186
        • Stunell H.
        • Buckley O.
        • Geoghegan T.
        • et al.
        Recurrent pyogenic cholangitis due to chronic infestation with Clonorchis sinensis.
        Eur Radiol. 2006; 16: 2612-2614