Hj. Kim et al., Characterization of primary pure cholesterol hepatolithiasis: cholangioscopic and selective cholangiographic findings, GASTROIN EN, 53(3), 2001, pp. 324-328
Background: Primary pure cholesterol hepatolithiasis has been described rec
ently. The aim of this study was to analyze Its clinical and radiologic fea
tures, focusing on the cholangioscopic and selective cholangiographic findi
ngs.
Methods: Primary pure cholesterol hepatolithiasis was identified in 3% (6 o
f 172) of patients who were treated with cholangioscopic stone removal for
primary hepatolithiasis during the study period from 1995 to 1999. These 6
consecutive patients (M/F 5:1, mean age 40 years) were enrolled in the stud
y. They underwent abdominal US, CT, endoscopic retrograde cholangiography (
ERC), and percutaneous transhepatic cholangioscopy (PTCS). After confirming
that the stones were of the cholesterol type, cholangioscopic stone remova
l via the percutaneous transhepatic route was performed. For the prevention
of recurrence, ursodeoxycholic acid (10 mg/kg/day) was prescribed during f
ollow-up.
Results: US demonstrated high echogenicity with strong shadowing in dilated
peripheral ducts, whereas CT failed to demonstrate any intraductal abnorma
l density or calcification except localized duct dilatation. PTCS demonstra
ted multiple, white to yellowish stones that were morphologically readily d
istinguishable from brown pigment intrahepatic stones. In all patients, sel
ective cholangiography disclosed the ductal abnormalities, which could not
be delineated by ERC in 4 patients. Complete stone removal by PTCS was achi
eved in 5 of 6 patients. During follow-up (12 to 49 months, mean 22 months)
, they were asymptomatic and stone recurrence was not detected by US.
Conclusions: Primary pure cholesterol hepatolithiasis is distinguishable fr
om the more common brown pigment hepatolithiasis by its cholangioscopic and
selective cholangiographic characteristics.