Therapeutic Endoscopy of the0Hepatobiliaryand Pancreatic System: A Vietnamese Experience, Anh L. X-Ray: All procedures were performed in the X-ray suite equipped as an operating theater with an image amplifier monitor. Data: Three hundred eighteen ERCP procedures were per- formed on 271 patients. Diagnostic endoscopy only was performed on 141 cases. Endoscopic treatment procedures were applied on 98 cases. Thirty-two cases failed ERCP with only duodenoscopy being performed. RESULTS Results of Endoscopic Treatment (98 cases): Gallstones: Gallstones were detected in 69 cases, three of which were intrahepatic and 66 of which exhibited com- mon bile duct stones. All intrahepatic stones were suc- cessfully extracted. Of the 66 cases of common bile duct stones, 48 (74%) were extracted successfully. Of these 48 cases, 21 patients had residual stones postoperatively. Of 27 cases with common bile duct stones, 14 were managed successfully with a mechanical lithotriptor (some stones being in excess of two centimeters in diameter).6, 11 Ascaris in the Common Bile Duct: Twenty-two patients were suggested by clinical and sonographic means to have Ascaris in the common bile duct. However, only 14 cases were found to have Ascaris by ERCP. Nasobiliary Drainage: Twelve cases underwent nasobil- iary drainage for decompression of the bile ducts.16,18,22 Stent Insertion: Three cases underwent biliary stent inser- tion.4,11,13 Special Circumstances: Two cases of ERCP were per- formed on patients who had undergone Billroth I gastrecto- my (partial gastrectomy). One ERCP procedure (diagnostic only) was completed on a patient who had undergone a Billroth II gastrectomy procedure. Of 324 cases performed to date, six have been on patients who have undergone laparoscopic cholecystectomy. This rate of 1.8% is low when compared to developed countries (10%).22 DISCUSSION Eight cases of 22 cases diagnosed as having Ascaris in the common bile duct had normal images on ERCP. However, five of the eight cases were found to have gas in the biliary tract, which might account for the colicky pain experienced by these patients. These findings may help explain why operative procedures for Ascaris in the biliary tract, diagnosed only by clinical or sonographic means, frequently failed to demonstrate any of the worms. In 14 cases, ERCP visualized ascarides in the common bile duct. In two of these cases, tails of the ascarides were detected outside the papilla of Vater. In most cases, only one Ascaris was present, but a few cases had up to five worms in the bile ducts which were extracted endoscopi- cally. After ascarides extraction, a completion cholan- giogram is recommended. The experiences of Binh Dan Hospital and Viet Nam in general suggest: A) Medical treatment: It has not been demonstrated that medical treatment can cause movement of Ascaris back into the digestive tract. Many cases managed conservatively suf- fered from complications such as cholangitis and liver abscess. Late complications include intrahepatic and biliary tract stone. Many cases were diagnosed to have Ascaris invading the biliary tract, but in fact, these patients had abdominal pain related to other causes. B) Surgical treatment: Many cases are operated on for invasion of the biliary tract by Ascaris. However, a signifi- cant number of these cases don't demonstrate Ascaris. In these cases a T-tube is inserted into the common bile duct because it has been incised to provide for exploration. If Ascaris is detected, T-tube insertion post worm extraction is mandatory. Six of the 14 cases of ERCP verified bile duct Ascaris required a sphincterotomy. Others have suggested that only a small incision is necessary as stone extraction is not being performed.2,3,14 Common Bile Duct Stones: Though this is a small series early in our experience, stone removal via endoscopy was successful in 48 of 69 cases (74%). Twenty-seven stones were greater than two cen- timeters in diameter, of which 14 were extracted by the bas- ket mechanical lithotriptor. The average hospital stay for first-time operative patients at Binh Dan Hospital for hepatobiliary and pancreatic disease is 22.5 days. For patients requiring operative procedures for residual stones, the average hospital stay is 25.3 days. For patients undergoing stone removal via ERCP tech- niques, the average hospital stay is five days or less. Emergency ERCP nasobiliary decompression of the biliary tract for impacted bile duct stones or pancreatitis due to 346 JSLS(1997)1:345-348