Non-invasive management of Ascaris lumbricoides biliary tact migration: a prospective study in 69 patients from Ecuador.

Ascariasis is one of the most common helminthic diseases. Its most feared complication is migration into the biliary tree. Some authors recommend immediate duodenoscopy in all cases of biliary migration, with sphincterotomy for the extraction of the parasites, and surgical extraction in case of intrahepatic ascariasis. We followed prospectively 69 patients with ultrasonographical evidence of migration. Initial treatment consisted of intravenous analgesics and antispasmodics, and albendazole 800 mg by mouth. Only patients with persisting symptoms or with high amylasaemia underwent duodenoscopy, with extraction in case of a visible worm. Surgery was limited to cases with persistent or progressive complications. In 97% of our cases the worms disappeared with noninvasive therapy alone. A duodenoscopy was done in 30 (42%) cases; in 10 (14%) a worm was found in the ampulla of Vater and extracted without sphincterotomy. In none of the 6 cases with A. lumbricoides in the intrahepatic biliary tree did the parasite persist. Only one patient required surgical intervention. Treatment of A. lumbricoides migration to the biliary tract should be principally medical. Duodenoscopy with extraction of a visible worm should be limited to cases with persisting pain and/or hyperamylasaemia. Invasive methods like sphincterotomy and surgery should be restricted to patients who do not respond to conservative treatment.