Recurrence after Ductal Dilatation of Intrahepatic Biliary Strictures in Patients with Hepatolithiasis: Long-term Follow up Study

Kwak, Yee Gyung; Jeong, Seok; Lee, Jin Woo; Lee, Don Haeng; Kim, Pum Soo; Kim, Hyung Gil; Cho, Yong Bum; Kwon, Kye Sook; Cho, Hyeon Guen; Shin, Yong Woon; Kim, Young Soo

Abstract

BACKGROUND/AIMS: Intrahepatic biliary stricture is one of the most common cause of treatment failure in hepatolithiasis, and it is also the main cause of stone recurrence. Ductal dilatation with percutaneous cholangioscopy is a promising therapy for biliary stricture, however the long- term outcome of this treatment modality has limited documentation. We performed the long-term follow up examination of these cases to investigate stone clearance and recurrence after percutaneous balloon dilatation, with or without stenting, and of stricture associated with intrahepatic cholelithiasis.
METHODS
From October 1996 to December 1999, 28 patients with hepatolithiasis and intrahepatic biliary stricture were treated with percutaneous transhepatic cholangioscopic or postoperative cholangioscopic lithotripsy, and balloon dilatation. Choledochoscopic electrohydraulic lithotripsy was applied when impacted or large stones were encountered. We studied clinical and radiological examination regularly to evaluate the complete clearance and recurrence of stone after ductal dilatation.
RESULTS
Complete clearance of stones was achieved in 23 patients (82.1%). The rate of stone recurrence in complete stone clearance group after mean follow up period of 41 months was 17.4%.
CONCLUSIONS
Balloon dilatation is an efficient method of complete stone removal and prevention of the stone recurrence in biliary stricture-associated hepatolithiasis.