Ascaris lumbricoides is one of the commonest human parasitic infestations in the developing world. Most of the ascaris infections are asymptomatic and clinical disease ismainly restricted to subjectswith heavywormload. Biliary migration of the wormcan lead to a wide variety of clinical syndromes and concomitant complications necessitating early diagnosis andmanagement. Various disease presentations include biliary colic, obstructive jaundice, acalculous cholecystitis, choledocholithiasis, pancreatitis, cholangitis, biliary strictures and hepatic abscesses. While laboratory tests are non-specific, radiological investigations demonstrate features highly suggestive of biliary ascariasis. The vast majority of patients respond to conservative measures. Endoscopic therapy is necessary in cases which fail to respond to conservative measures or in patients presenting with complicated disease. Worms visible at the ampulla may be extracted endoscopically prior to attempting more intrusive forms of therapy. Sphincterotomy should be avoided for worm extraction since an open biliary sphincter facilitates future disease recurrences should worm reinfestation occur. Recurrence of the disease is frequent due to re-infestations. Wormeradication with anti-helminthic therapy is essential after biliary disease resolution.