Endoscopic treatment is less traumatic than live roundworms Ascariasis is a disease caused by the parasitism of earthworm nematodes (Ascaris lumbricoides) in the small intestine of human beings, and it is a common and frequent disease in rural areas and pastoral areas where the standard of living is relatively low. In recent years, the incidence of ascariasis has increased among people who favor eating raw vegetables. In the gastrointestinal endoscopy ward, a patient with abdominal pain and pancreatitis as the first symptom was admitted. During ultrasonic gastroscopy, a live Ascaris lumbricoides was found in the duodenum, which was about 20cm in length, and was removed endoscopically, and there were typical bilateral shadows on ultrasound scanning of the intrahepatic bile ducts. Combined with the patient’s history, physical signs and the ultrasound endoscopy, the patient was considered to be suffering from biliary ascariasis with secondary pancreatitis, so he decided to carry out ERCP examination, and during the examination, he found that the two ends of a live roundworm were located in the left hepatic duct and the right hepatic duct, due to the deep location of the roundworm, and because of the patient’s thin intra- and inter-hepatic bile ducts, it was difficult for the reticulated blue net and the balloon to capture the worm, Director Sun Siyu, undaunted by the difficulties, successfully used the balloon to pull the roundworm from the intrahepatic biliary ducts to the biliary ducts respectively, and then removed it under endoscope. After one hour of struggle, he successfully used the balloon to drag the head and tail of the roundworm from the intrahepatic bile duct to the common bile duct, and used foreign body forceps to remove the roundworm from the biliary tract, which was about 25cm in length, and the patient’s abdominal pain symptoms were relieved rapidly after the removal. Biliary ascariasis has a rapid onset, often combined with jaundice, cholangitis, pancreatitis and other diseases, which is more harmful to the patients. Endoscopic biliary roundworm removal is less traumatic, efficacious, and can achieve immediate results, which is the first choice for the treatment of this disease, but the endoscopic operation of intrahepatic biliary roundworms is difficult, and is seldom reported both at home and abroad. Director of Endoscopy Center Sun Siyu reminded the patients that they should pay attention to food hygiene when eating green vegetables to prevent the disease from entering from the mouth. Ascaris lumbricoides occupying the right and left hepatic ducts during the removal process The body of Ascaris lumbricoides taken out by endoscopy