Percutaneous transhepatic cholangioscopic treatment for hepatolithiasis: an evaluation of long-term results and risk factors for recurrence

Background: Percutaneous transhepatic cholangioscopy (PTCS) has a major rol e in the treatment of hepatolithiasis. The aims of this study were to evalu ate immediate and long-term results of PTCS treatment and to elucidate the risk factors for recurrence of stones or cholangitis. Methods: A retrospective study was conducted of patients with hepatolithias is who underwent PTCS treatment. A total of 92 patients underwent PTCS trea tment and 68 were followed for 24 to 60 months (median 42 months). Results: Complete clearance of stones was achieved in 74 (80%) patients. Th e rate of complete clearance was significantly lower in patients with sever e intrahepatic strictures compared with that for those with no strictures ( 14 of 24, 58% vs. 16 of 16, 100%, p < 0.01) and those with mild to moderate strictures (14 of 24, 58% vs. 44 of 52, 85%, p < 0.05). Patients with seve re intrahepatic strictures had a higher recurrence rate than those with no or mild strictures (100% vs. 28%, p < 0.01). In addition the recurrence rat e in patients with advanced biliary cirrhosis (Child's class B or C) was hi gher than in those with no or mild (Child's class A) cirrhosis (89% vs. 29% , p < 0.01). In patients with type I and II hepatolithiasis (Tsunoda classi fication), stones recurred in 2 (12%) patients at 28 and 32 months after su ccessful stone removal, without further recurrence afterwards. The recurren ce rate in patients with type III and IV hepatolithiasis increased graduall y up to 50% at 60 months of follow-up. Conclusions: Severe intrahepatic stricture was the only factor that affecte d the immediate success rate of PTCS in the treatment of hepatolithiasis, S everal risk factors including severe biliary stricture, advanced biliary ci rrhosis and Tsunoda type III and IV affected the long-term results.