title: Endoscopic therapy of fascioliasis resistant to oral therapy.
abstract: BACKGROUND
  We present an endoscopic approach to patients with fascioliasis resistant to oral pharmacotherapy. A staged study was performed in which the effect of flushing the biliary system with a fasciolicidal solution was evaluated.
  
  
  METHODS
  In phase I of the study, four agents (povidone iodine, potassium permanganate, chlorhexidine, and sodium bicarbonate) were tested in vitro for their effect on Fasciola worm viability. In phase II, patients resistant to oral pharmacotherapy for fascioliasis were referred for endoscopic retrograde 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 Fasciola worm viability. Nine patients had the biliary system flushed with povidone iodine. The presence of a Fasciola worm was demonstrated in the bile duct of all patients. In one patient an extra worm was found in the gallbladder. All patients were negative for Fasciola ova on repeated follow-up stool examination.
  
  
  CONCLUSIONS
  We recommend washing the biliary system of patients with fascioliasis resistant to oral pharmacotherapy with povidone iodine because it is effective against the worms in the bile ducts and gallbladder and usually leaves the patient with an intact papilla.
authors.affiliation: Department of Surgery, Medical Research Institute, University of Alexandria, Egypt.
authors.forename: N
authors.initials: N
authors.lastname: Dowidar
authors.forename: M
authors.initials: M
authors.lastname: El Sayad
authors.forename: M
authors.initials: M
authors.lastname: Osman
authors.forename: A
authors.initials: A
authors.lastname: Salem
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D001562:Benzimidazoles / Q000008:administration & dosage; D002648:Child; D002710:Chlorhexidine / Q000008:administration & dosage; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004351:Drug Resistance; D005211:Fascioliasis / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D011196:Potassium Permanganate / Q000008:administration & dosage; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011817:Rabbits; D017693:Sodium Bicarbonate / Q000008:administration & dosage; D016896:Treatment Outcome; D000077682:Triclabendazole
chemical_list: D000871:Anthelmintics; D000891:Anti-Infective Agents, Local; D001562:Benzimidazoles; D011196:Potassium Permanganate; D000077682:Triclabendazole; D011206:Povidone-Iodine; D017693:Sodium Bicarbonate; D002710:Chlorhexidine