title: Hepatolithiasis: outcome of cholangioscopic lithotomy and dilation of bile duct stricture.
abstract: BACKGROUND
  Cholangioscopic lithotomy (CSL) for hepatolithiasis, a minimally invasive procedure, has a place in complicated or recurrent hepatolithiasis. CSL itself, however, carries inherent risk for recurrence. We analyzed follow-up data after CSL for primary or repeat hepatolithiasis to determine the frequency of recurrence.
  
  
  METHODS
  This retrospective analysis includes 21 patients with hepatolithiasis admitted to the hospital from September 1992 to December 1995 who underwent CSL. Through a percutaneous biliary drainage route, cholangioscopy was inserted to remove calculi with basket forceps or electrohydraulic lithotripter. Stenotic ducts, defined as less than 2 mm in diameter, were dilated with silicone rubber stenting or a balloon dilator.
  
  
  RESULTS
  Ten patients were treated for primary hepatolithiasis and 11 for repeat hepatolithiasis. Of the patients with primary hepatolithiasis, one died of complications and the other nine patients underwent complete lithotomy. Among 11 patients who had repeat hepatolithiasis, four had undergone hepatectomy for hepatolithiasis and two previous CSLs; 10 patients (91%) underwent complete lithotomy. During the follow-up, four (40%) of the 10 patients with biliary stenosis at the time of cholangioscopic treatment showed recurrent calculi, whereas all eight patients without stricture had uneventful courses. Of the 19 patients who underwent complete lithotomy, calculi recurred in four (21%), three cases of which recurred less than 1 year after CSL.
  
  
  CONCLUSIONS
  Against hepatolithiasis of primary and postoperative repeat cases, CSL can allow complete lithotomy. The bile duct stricture, however, carries a high risk for recurrent calculi; hence, permanent relief of stricture is mandatory.
authors.affiliation: Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Yoshida
authors.forename: K
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: S
authors.initials: S
authors.lastname: Shimizu
authors.forename: H
authors.initials: H
authors.lastname: Sato
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D002404:Catheterization; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome