Bahcecioglu Ibrahim H, Tawheed Ahmed, Tunc Nurettin, Artas Hakan, Madkour Ahmad, Cicek Sedat, Yalniz Mehmet
Firat University, Faculty of Medicine, Department of Gastroenterology, Elazig, Turkey.
Endemic Medicine Department, Helwan University, Cairo, Egypt.
J Clin Exp Hepatol. 2024 Nov-Dec;14(6):101476. doi: 10.1016/j.jceh.2024.101476. Epub 2024 Jul 2.
Hepatobiliary fascioliasis has two phases, each requiring specific management approaches. Triclabendazole has been widely effective in treating the two phases of clinical fascioliasis and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary phase. We aimed to characterize presentations of hepatobiliary fascioliasis and highlight the role of ERCP in management.
This retrospective cohort includes patients diagnosed with clinical hepatobiliary fascioliasis between January 2013 and December 2022. Demographic data, clinical presentation, laboratory and radiological investigations, treatment, and endoscopy reports were collected from the records of 62 participants. Patients were divided into two groups: acute hepatic and chronic biliary phases.
Thirty-six patients were in the biliary phase, and 26 were in the hepatic phase. All patients were from rural areas, and females were predominant (76%). Hypereosinophilia was detected in 92% of acute cases and 58% of chronic biliary cases. In chronic biliary cases, the levels of liver biochemicals, including alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and bilirubin, were higher at levels of 189 ± 76, 127 ± 47, 268 ± 77, and 2.4 ± 0.7 respectively, compared to acute hepatic cases, 35.6 ± 8.2, 32.7 ± 4.3, 69.2 ± 45.45, and 0.58 ± 0.01. The corresponding -values were 0.003, 0.001, <0.001, and <0.001, respectively. Triclabendazole effectively cured 93.5% of patients and was used in combination with ERCP in biliary-phase cases where the fluke was extracted from the biliary system in 34 patients (94.4%). Three patients (8.8%) were diagnosed with post-ERCP pancreatitis. None of the patients experienced bleeding, perforation, or required biliary stenting.
Clinical fascioliasis could manifest in acute hepatic or chronic biliary phases. Hypereosinophilia was more evident in the hepatic phases, while ALT, AST, GGT, and bilirubin were higher in the biliary phase. Triclabendazole is effective in the hepatic phase and when combined with ERCP in the biliary phase. ERCP is highly effective for relieving obstruction and treating biliary fascioliasis.
肝胆片形吸虫病有两个阶段，每个阶段都需要特定的管理方法。三氯苯达唑在治疗临床片形吸虫病的两个阶段以及胆道期的内镜逆行胰胆管造影（ERCP）方面已被广泛证明有效。我们旨在描述肝胆片形吸虫病的表现，并强调ERCP在管理中的作用。
这项回顾性队列研究纳入了2013年1月至2022年12月期间被诊断为临床肝胆片形吸虫病的患者。从62名参与者的记录中收集了人口统计学数据、临床表现、实验室和影像学检查、治疗及内镜检查报告。患者分为两组：急性肝期和慢性胆道期。
36例患者处于胆道期，26例处于肝期。所有患者均来自农村地区，女性占多数（76%）。92%的急性病例和58%的慢性胆道病例检测到嗜酸性粒细胞增多。在慢性胆道病例中，包括丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰转移酶（GGT）和胆红素在内的肝脏生化指标水平分别为189±76、127±47、268±77和2.4±0.7，高于急性肝期病例，急性肝期病例相应指标水平分别为35.6±8.2、32.7±4.3、69.2±45.45和0.58±0.01。相应的P值分别为0.003、0.001、<0.001和<0.001。三氯苯达唑有效治愈了93.5%的患者，在胆道期病例中与ERCP联合使用，34例患者（94.4%）的吸虫从胆道系统中取出。3例患者（8.8%）被诊断为ERCP术后胰腺炎。没有患者出现出血、穿孔或需要胆道支架置入。
临床片形吸虫病可表现为急性肝期或慢性胆道期。嗜酸性粒细胞增多在肝期更明显，而ALT、AST、GGT和胆红素在胆道期更高。三氯苯达唑在肝期有效，在胆道期与ERCP联合使用有效。ERCP在缓解梗阻和治疗胆道片形吸虫病方面非常有效。
