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DOI: 10.1055/a-2608-0545
Radiation-free extraction of intrahepatic biliary ascariasis in a pregnant patient using peroral cholangioscopy: a case report
A 23-year-old woman at 7 weeks of gestation was admitted with a 2-day history of abdominal pain. Abdominal ultrasonography identified biliary ascariasis ([Fig. 1]), while gynecological ultrasound confirmed a viable intrauterine early pregnancy. Laboratory findings were unremarkable. In light of the patient’ s desire to continue the pregnancy, a radiation-free endoscopic approach for worm extraction via oral cholangioscopy was planned.
Cannulation was successfully performed using a wire-guided sphincterotome. Aspiration of yellow bile confirmed the guidewire’s entry into the common bile duct ([Fig. 2]). The sphincterotome was withdrawn smoothly after bowing. Given that the migration of the Ascaris into the bile duct had sufficiently dilated the papilla, sphincterotomy was deemed unnecessary and omitted. The EyeMax (Micro-tech) was advanced into the common bile duct along the guidewire, and the ascaris was successfully extracted ([Video 1], [Fig. 3]). The patient experienced no postoperative complications.
Pregnancy is a well-documented risk factor for biliary ascariasis [1]. While endoscopic retrograde cholangiopancreatography (ERCP) remains a critical therapeutic modality, its associated radiation exposure poses potential risks to the fetus. In this context, oral cholangioscopy offers a safe and efficient alternative for ascaris removal without radiation exposure. Notably, a novel endoscopic retrograde direct cholangioscopy (ERDC) technique has been developed to facilitate visible biliary duct cannulation [2], further enhancing the feasibility and safety of this approach.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 Khuroo MS, Rather AA, Khuroo NS. et al. Hepatobiliary and pancreatic ascariasis. World J Gastroenterol 2016; 22: 7507-7517
- 2 Liu WH, Huang XY, Hu X. et al. Initial experience of visualized biliary cannulation during ERCP. Endoscopy 2023; 55: 1037-1042
Correspondence
Publication History
Article published online:
02 July 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Khuroo MS, Rather AA, Khuroo NS. et al. Hepatobiliary and pancreatic ascariasis. World J Gastroenterol 2016; 22: 7507-7517
- 2 Liu WH, Huang XY, Hu X. et al. Initial experience of visualized biliary cannulation during ERCP. Endoscopy 2023; 55: 1037-1042