Management of biliary ascariasis: Report of 21 cases

This study was carried out to assess the management of biliary ascariasis with special reference to endoscopic treatment. From January 1, 1986 to December 31, 1996, twenty one cases of biliary ascariasis were detected at endoscopic retrograde cholangio-pancreatography (ERCP) examination. Thirteen of 21 patients (62%) presented with recurrent biliary colic and the remaining 8 patients (38%) developed acute cholangitis. Ultrasound (US) using a real time scanner detected the worm in the CBD in 7 of 13 (54%) patients examined. Three of 21 patients had prior sphincterotomy for removal of common ble duct (CBD) stones and 4 patients had concurrent CBD stones at ERCP. Seventeen patients (81%) underwent a small sphincterotomy followed by extraction of worm with a dormia basket. Removal of worm was successful in 11 (65%) of these patients, whereas in the other 6 patients a naso-biliary tube was inserted for the administration of pyrantel pamoate directly into the bile duct. Interval duct clearance was obtained in all these 6 patients at subsequent tube cholangiography. The remaining 4 patients (19%) with CBD stones underwent uneventful surgery. In conclusion, US and ERCP are very useful in the diagnosis of biliary ascariasis and endoscopic treatment should be considered as the first treatment of choice for those patients with symptomatic biliary obstruction and acute cholangitis.