title: Significance of controlling chronic proliferative cholangitis in the treatment of hepatolithiasis.
abstract: BACKGROUND
  Recently, high stone recurrence and biliary restenosis rates in hepatolithiasis patients have been confirmed to be closely related to chronic proliferative cholangitis (CPC). However, the effective management of CPC has not yet been established.
  
  
  RESULTS
  A vicious cycle exists between the presence of intrahepatic calculi and CPC: both the stone itself and secondary biliary infection can stimulate persistent hyperplasia in the biliary duct wall, leading to the occurrence of CPC and biliary stricture. The recurrent attacks of CPC will, in turn, facilitate new stone formation via mucoglycoprotein production, or induced biliary stricture and cholestasis. Thus, even when the stone is completely removed and the biliary tract stenosis is corrected, residual CPC will persist and progress, with an underlying risk for postoperative stone recurrence and biliary tract restenosis. Therefore, the perfect hepatolithiasis treatment would target stone removal and correction of the biliary tract stricture, as well as control of postoperative residual CPC. In fact, CPC, the management of which has been traditionally ignored, is the key to breaking this vicious cycle.
  
  
  CONCLUSIONS
  Overall, the subsequent treatment of residual CPC after operation or choledochoscopic lithotomy would be helpful to decrease postoperative stone recurrence and the rate of biliary restenosis. Adding such treatment would reduce the incidence of surgical reintervention and choledochoscopic lithotomy, and it would also improve the postoperative hepatolithiasis outlook.
authors.affiliation: Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, China. lfy_74@vip.163.com
authors.forename: Fu Yu
authors.initials: FY
authors.lastname: Li
authors.forename: Nan Sheng
authors.initials: NS
authors.lastname: Cheng
authors.forename: Hui
authors.initials: H
authors.lastname: Mao
authors.forename: Li Sheng
authors.initials: LS
authors.lastname: Jiang
authors.forename: Jing Qiu
authors.initials: JQ
authors.lastname: Cheng
authors.forename: Quan Sheng
authors.initials: QS
authors.lastname: Li
authors.forename: Sanjay
authors.initials: S
authors.lastname: Munireddy
mesh_terms: D002761:Cholangitis / Q000150:complications / Q000628:therapy*; D002780:Cholestasis, Intrahepatic; D002908:Chronic Disease; D006801:Humans; D020347:Lithiasis / Q000209:etiology* / Q000628:therapy; D008107:Liver Diseases / Q000209:etiology* / Q000628:therapy; D011379:Prognosis