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Background and study aims > Primary pure cholesterol hepatolithiasis in which cholesterol is more than 90% of stone weight have been recently reported. Our study was aimed to a ialyze its clinical and radiological features focused on the cholangioscopic and selective cho-Lngiographic findings and to elucidate proper treatment modality. From 1995 to 1999, six consecutive patients (M/F 5: 1, mean age 40 yr) with final diagnosis o primary pure cholesterol hepatolithiasis in Asan Medical Center were enrolled. They u lderwent abdominal utrasonography, CT scan, endoscopic retrograde cholangiography (ERC), aid percutaneous transhepatic cholangioscopy (PTCS). After confirmation of cholesterol stone, c iolangioscopic stone removal via the percutaneous transhepatic route was followed by oral cl issolution therapy with ursodeoxycholic acid (LTDCA, 10 mg/kg/day). Primary p.zre cholesterol hepatolithiasis was identified in 3% (6/172) of patients who were treated with c iolangioscopic stone removal for primary hepatolithiasis in Asan Medical Center during the study period. Sonography demonstrated high echogenic materials with strong posterior shadow ii L dilated peripheral ducts, whereas CT scan failed to show any of intraductal abnormal d-,nsity or calcification except localized duct dilatation. PTCS demonstrated multiple, white to yallowish stones which is morphologically quite distinguishable from brown pigment irltrahepatic stones. In all the patients, selective cholangiography disclosed abnormal ductal h Sion, which could not be delineated by ERC in 4 patients. The ductal changes were confined tc, the peripheral stone-bearing ducts. Ductal stricture was not prominent (2 of no stricture, 4 of mild stricture). Complete stone removal by PTCS was achieved in 5 of 6 patients. During f0 flow-up period of 12-49 months (mean 22 months) with UDCA, they were free of symptoms aid sonographical stone recurrence was not demonstrated. < Conclusions > Primary pure choir sterol hepatolithiasis is distingushable from usual brown pigment hepatolithiasis by its c iaracteristic cholangioscopic and selective cholangiographic findings. Stone removal by PTCS a 1d subsequent long term UDCA administration may be recommended with first priority for the treatment of pure cholesterol hepatolithiasis.
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