Endoscopic therapy of fascioliasis resistant to oral therapy

Background: We present an endoscopic approach to patients with fascioliasis resistant to oral pharmacotherapy, A staged study was performed in which t he effect of flushing the biliary system with a fasciolicidal solution was evaluated. Methods: In phase I of the study, four agents (povidone iodine, potassium p ermanganate, chlorhexidine, and sodium bicarbonate) were tested ire vitro f or their effect on Fasciola worm viability. In phase II, patients resistant to oral pharmacotherapy for fascioliasis were referred for endoscopic retr ograde cholangiopancreatography and flushing of the biliary system with the solution found to be most effective in phase I. Results: Povidone iodine proved to be the most effective solution against F asciola worm viability, Nine patients had the biliary system flushed with p ovidone iodine, The presence of a Fasciola worm was demonstrated in the bil e duct of all patients, In one patient an extra worm was found in the gallb ladder, All patients were negative for Fasciola ova on repeated followup st ool examination, Conclusions: We recommend washing the biliary system of patients with fasci oliasis resistant to oral pharmacotherapy with povidone iodine because it i s effective against the worms in the bile ducts and gallbladder and usually leaves the patient with an intact papilla.