title: Percutaneous transhepatic placement of metallic stents in the treatment of complicated intrahepatic biliary stricture with hepatolithiasis: a preliminary report.
abstract: OBJECTIVE
  We aimed to study the effect of the metallic modified Gianturco-Rosch Z-stent in the management of refractory intrahepatic long-segment biliary strictures with hepatolithiasis.
  
  
  METHODS
  Six symptomatic patients with hepatolithiasis and coexisting intrahepatic long-segment biliary strictures, who failed to respond to the silastic external-internal biliary stenting, were selected. The metallic modified Gianturco-Rosch Z-stent was placed via percutaneous transhepatic cholangiography at the strictured site. Patients were followed regularly to evaluate for recurrence of cholangitis, stones, or strictures.
  
  
  RESULTS
  No complications were observed during the procedures. No recurrent strictures or formed calculi were found in these six patients during follow-up periods of 29 to 64 months. However, cholangitis and intrahepatic biliary muddy sludge occurred at 7 and 30 months in two patients after the placement of the metallic Z-stent. Percutaneous transhepatic cholangioscopy was used to clear sludge completely.
  
  
  CONCLUSIONS
  Our experience suggests that the metallic stent is a well-tolerated and promising alternative in the management of refractory intrahepatic long-segment biliary strictures with hepatolithiasis. Though biliary sludge may develop, it can be detected and cleared early. Repeated surgery can thus be avoided.
authors.affiliation: Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
authors.forename: K S
authors.initials: KS
authors.lastname: Jeng
authors.forename: I S
authors.initials: IS
authors.lastname: Sheen
authors.forename: F S
authors.initials: FS
authors.lastname: Yang
authors.forename: S J
authors.initials: SJ
authors.lastname: Cheng
authors.forename: I
authors.initials: I
authors.lastname: Ohta
mesh_terms: D002758:Cholangiography; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000628:therapy; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000628:therapy*; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging / Q000628:therapy*; D004724:Endoscopy; D004867:Equipment Design; D005500:Follow-Up Studies; D006801:Humans; D012008:Recurrence; D019233:Retreatment; D015607:Stents