Poster Session：PS 1154 ; Gastroenterology (Pancreatobilliary) : Biliary Ascariasis Infestation after Endoscopic Sphincterotomy

Ascarias lumbricoides is a common parasitic infestation in gastrointestinal tract. Migration of adult worm to biliary system implicates biliary complication. Interestingly, biliary ascariasis is known as one of the complication of EST in endemic area. But biliary ascariasis after endoscopic sphicterotomy is rarely reported in Korea. We report the case of biliary ascariasis caused after performing EST for treatment of common bile duct stones. 58- year-female Combodian from South East Asia visited our hospital for epigastric pain from 2 weeks ago. Laboratory fi nding revealed AST 122 IU/L, ALT 35 IU/L, ALP 122 IU/L, GGT 244 IU/L. CT scan showed multiple large stones in common bile duct. We extracted multiple brown stones by basket after endoscopic sphincterotomy and endoscopic papillary large balloon dilatation. Next day, we performed follow up ERCP for removal of remnant CBD stones. On cholangiogram, giant roundworm with remnant stone was noted in CBD, which wasn`t seen at prior ERCP. We caught the worm by snare and successfully pulled it out from common bile duct. The worm, 30cm long, round, whitish-pink colored, was identified as ascariasis lumbricoides. We detected round worm after performing endoscopic sphincterotomy which wasn`t noticed at fi rst ERCP. The worm seems to migrate to common bile duct easily because opening of major papilla was widened after EST. As the demand for organic food and immigration from endemic area increase in Korea, biliary ascariasis should be considered a diagnostic possibility especially in patient from the tropics.