Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
ABSTRACT
Hepatolithiasis can cause recurrent attacks of cholangitis or biliary cirrhosis. Definitive treatment should aim for complete elimination of bile stasis and removal of the entire stones. Endoscopic retrograde cholangiopancreatography is not well established for hepatolithiasis because of frequent failures due to associated biliary strictures, angulated ducts or peripherally impacted stones. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) for the treatment of hepatolithiasis is particularly suited for those patients who poor surgical risks or who refuse surgery and those with previous biliary surgery or stones distributed in multiple segments. PTCSL is a relatively safe and effective for treating hepatolithiasis, and that complete stone clearance is mandatory to diminish the sequelae of hepatolithiasis. Intrahepatic duct stricture is the main factor contributing to incomplete clearance and stone recurrence. Long-term follow-up is required because the overall recurrence rate of hepatolithiasis is high and hepatolithiasis is also associated with cholangiocarcinoma. Oral dissolution therapy may be effective for the prevention of recurrence after removal of cholesterol hepatolithiasis by PTCSL.
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