title: Percutaneous endoscopic management of intrahepatic stones in patients with altered biliary anatomy: A case series.
abstract: Incidence of primary intrahepatic stones (IHS) in India is very less as compared to the Far East. However patients with altered biliary anatomy are prone for IHS formation secondary to anastomotic stricture formation. Indian data on percutaneous endoscopic management of IHS is scare. Five patients with IHS were managed percutaneously. All patients had undergone Roux-en-Y hepaticojejunostomy and were not suitable for direct endoscopic intervention. All patients underwent percutaneous biliary drainage followed by cholangioscopy-guided laser lithotripsy. Crushed stones were pushed across the anastomotic site using basket/balloon and ductal clearance was achieved. Good stone pulverization could be achieved in five patients (100 %). Complete ductal clearance could be achieved in all patients (100 %). Cholangioscopy-guided treatment of IHS can be valuable alternative to surgery in select group of patients especially those having dilated biliary tree with absence of intrahepatic strictures. However long-term follow up studies are required to see for recurrence of stone formation.
authors.affiliation: Baldota Institute of Digestive Sciences, 3rd Floor, Global Hospitals, 35, Dr. E Borges Road, Opp Shirodkar High School, Parel East, Mumbai, 400 012, India. drsurya_b@yahoo.com.
authors.forename: Suryaprakash
authors.initials: S
authors.lastname: Bhandari
authors.affiliation: Baldota Institute of Digestive Sciences, 3rd Floor, Global Hospitals, 35, Dr. E Borges Road, Opp Shirodkar High School, Parel East, Mumbai, 400 012, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Bathini
authors.affiliation: Baldota Institute of Digestive Sciences, 3rd Floor, Global Hospitals, 35, Dr. E Borges Road, Opp Shirodkar High School, Parel East, Mumbai, 400 012, India.
authors.forename: Atul
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Baldota Institute of Digestive Sciences, 3rd Floor, Global Hospitals, 35, Dr. E Borges Road, Opp Shirodkar High School, Parel East, Mumbai, 400 012, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Maydeo
mesh_terms: D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D002114:Calcinosis / Q000601:surgery*; D004322:Drainage / Q000379:methods; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods; D017602:Lithotripsy, Laser / Q000379:methods; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Holmium laser lithotripsy; Intrahepatic stones; Percutaneous biliary drainage; Single-operator cholangioscopy