Stool examination will reveal adult worms or eggs in infected persons. Peripheral eosinophilia is only present during the tissue migration phase of infection. Serum conjugated bilirubin level is only mildly elevated because bile flows into the spaces between the cylindrical worms. However, most children with hepatobiliary or pancreatic ascariasis have elevated alkaline phosphatase levels.4 US is an effective noninvasive imaging modality, although the sensitivity is low. Endoscopic US may be more sensitive in the evaluation of the cause for dilated CBD. The US appearances of CBD include a single, long, linear, or curved echogenic nonshadowing structure without an inner tube (stripe sign); a thick, long, linear, or curved nonshadowing echogenic stripe containing a central anechoic tube (inner-tube sign); and multiple long, linear, overlapping echogenic structures due to coiling of worms (spaghetti sign).