Department of Gastroenterology, School of Digestive and Liver Diseases (SDLD), IPGMER & SSKM Hospital, Kolkata, India.
Department of Gastroenterology, School of Digestive and Liver Diseases (SDLD), IPGMER & SSKM Hospital, Kolkata, India.
Arab J Gastroenterol. 2021 Jun;22(2):164-169. doi: 10.1016/j.ajg.2020.11.002. Epub 2021 Mar 19.
Anti-helminthic therapy and endoscopic worm extraction had variable success rates in biliary ascariasis. Recurrent biliary events after worm clearance are common. We aimed to evaluate the outcomes of management in biliary ascariasis and find out the incidence and risk factors for the development of recurrent biliary events.
Consecutive patients with biliary ascariasis detected on abdominal ultrasound (AUS), were selected. Initial conservative treatment with oral Albendazole (400 mg) and analgesics was started in all. Successful therapy was defined as symptomatic resolution, and AUS confirmed biliary clearance after three weeks. ERCP (Endoscopic retrograde cholangiopancreatography) was performed in patients with failed conservative management. The patients were prospectively followed up for a minimum period of 1 year.
Among 98 patients with biliary ascariasis, 23 (23.5%) responded to medical management alone. A presentation with obstructive jaundice (p = 0.04) and cholangitis (p = 0.007) was significantly associated with failure to medical management. Sixty-five (86.7%) among 75 patients had successful biliary clearance with ERCP. During a median follow up of 16 months, 24 (24.5%) patients had recurrent biliary events. Lower socioeconomic status (OR = 0.78, p = 0.023) and longer follow-up (OR = 1.16, p = 0.001) were independent risk factors for recurrent biliary events.
Early ERCP among high-risk patients and proper hygiene are the keys to successful management in biliary ascariasis.
驱虫治疗和内镜下取虫在胆系蛔虫病中的成功率各不相同。清除蛔虫后，胆道再次发生疾病的情况较为常见。本研究旨在评估胆道蛔虫病的治疗效果，找出胆道再次发生疾病的发生率和危险因素。
连续选择经腹部超声（AUS）检测出胆系蛔虫病的患者。所有患者均接受口服阿苯达唑（400mg）和镇痛药的初始保守治疗。成功治疗定义为症状缓解，且 AUS 确认治疗 3 周后胆道内蛔虫清除。对保守治疗失败的患者进行 ERCP（经内镜逆行胰胆管造影术）。对患者进行前瞻性随访，随访时间至少为 1 年。
98 例胆系蛔虫病患者中，23 例（23.5%）仅接受药物治疗即可缓解。表现为阻塞性黄疸（p=0.04）和胆管炎（p=0.007）与药物治疗失败显著相关。75 例患者中有 65 例（86.7%）通过 ERCP 成功清除胆道内蛔虫。在中位随访 16 个月期间，24 例（24.5%）患者出现胆道再次发生疾病。较低的社会经济地位（OR=0.78，p=0.023）和较长的随访时间（OR=1.16，p=0.001）是胆道再次发生疾病的独立危险因素。
对于高危患者，早期进行 ERCP 和适当的卫生措施是成功治疗胆系蛔虫病的关键。
