title: Endoscopic intervention for hepatolithiasis associated with sharp angulation of right intrahepatic ducts.
abstract: BACKGROUND
  Hepatolithiasis (intrahepatic stones) is common in Asian patients. Hepatolithiasis with intrahepatic strictures and sharp ductal angulation poses a particularly difficult management problem.
  
  
  METHODS
  Cases of hepatolithiasis with sharp angulation of right intrahepatic ducts were retrospectively reviewed.
  
  
  METHODS
  Five patients with hepatolithiasis and right sharp intrahepatic ductal angulation were treated endoscopically via ERCP. Two patients died soon after the procedure. In the remaining 3 patients, treatment by dilation of the intrahepatic strictures and stent placement was only partially successful. Attempts to access the sharply angulated intrahepatic duct were unsuccessful.
  
  
  CONCLUSIONS
  Endoscopic management of hepatolithiasis associated with sharp angulation of a right intrahepatic duct is difficult and is generally managed best with percutaneous treatment modalities or surgery, where possible.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Mahadeva
authors.forename: Ranjeev
authors.initials: R
authors.lastname: Prabakharan
authors.forename: Khean-Lee
authors.initials: KL
authors.lastname: Goh
mesh_terms: D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D002137:Calculi / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002780:Cholestasis, Intrahepatic / Q000150:complications; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents