A case of missed biliary ascariais: Endoscopic retrograde cholangiography still remains the gold standard

| October 2012 | 990 l e t t e r t O e d it O r operator dependency and poor visualization of lower CBD are other limitations of US, for detection of biliary ascariasis. MRCP is very accurate in providing detailed information of the biliary system, without operator‐ dependency. It shows intraductal ascaris as linear hypointense filling defects.[5] However, in this case, the worm remained undetected by both modalities (US and MRCP). The migration of the worm out of the CBD remains a possibility; however, with progressive worsening of symptoms, this is questionable. The easy detection and removal of the worm by ERCP suggests that it is still the gold standard for this condition. Biliary sphincterotomy is frequently performed during ERCP,[6] and it is considered to be a risk factor for biliary ascariasis. It is well‐known that MRCP has a poorer resolution than ERCP, and it can miss certain lesions like small stones, small ampullary tumor, and strictures. However, whether it can miss a large worm has not been reported.