WORM EXTRACTION AND BILIARY DRAINAGE IN HEPATOBILIARY AND PANCREATIC ASCARIASIS

From December 1989 to March 1992, 50 (32%) of 156 patients with hepato biliary and pancreatic ascariasis underwent various endoscopic interve ntional procedures. Endoscopic intervention was performed when patient s did not respond to energetic symptomatic treatment within the first few days of hospitalization (n = 45) or when worms had not moved out o f the ducts into the duodenum at 3 weeks (n = 5). Worm extraction was successful in all 18 patients from the ampullary orifice and in 34 (89 .5%) of 38 patients from the bile or pancreatic duct. In five patients with pyogenic cholangitis, endoscopic nasobiliary drainage was perfor med to decompress the bile ducts. After worm extraction/nasobiliary dr ainage, 41 (91%) of the 45 patients with biliary disease (n = 42) or a cute pancreatitis (n = 3) had rapid relief of symptoms. Three patients developed complications related to endoscopy, including cholangitis ( n = 2) and hypotension (n = 1).