Hepatolithiasis and cholesterol and bile acid metabolism

Hepatolithiasis-epidemiology and pathogenesis update

“…Shenyang in northeastern China had a higher relative proportion of hepatolithiasis to all cholelithiasis, i.e., 21.1% (10), while in Beijing it was only 9.2% (10). In the Western world, the prevalence of hepatolithiasis seems to be much less, less than 1% (17,18), as revealed by only occasional reports emerging from the West. However, the overall relative proportion of hepatolithiasis is increasing, since the number of immigrants from endemic areas entering the West is considerably increasing.…”

Classification, Composition and Structure of Gallstones. Relevance of these Parameters for Clinical Presentation and Treatment

“…Brown stones specifically form in the bile ducts, either in the common duct or within the intrahepatic ducts, and usually form in the bile tract after liver transplantation or primary excision of choledochal cysts [54,56]. Only 60% of all intrahepatic stones are brown [64][65][66][67][68][69], whereas almost all gallstones entirely formed in the lower common bile duct (CBD) are brown, along with those stones that form cranially to a stricture in the sphincteric portion of the common bile duct after surgical or endoscopic sphincterotomy [13][14]. The same mechanism that is responsible for brown stone formation (bile stasis plus infection) is likely to be responsible for the obstruction of biliary endoprostheses by brown "mud", which has the same composition as brown stones [70][71][72].…”

“…A "brown" periphery can sometimes be found, because of secondary precipitations of "infectious" material, due to the long-term stay within the common duct of a cholesterol nucleus initially formed elsewhere [5]. It has recently been suggested that gallstones usually form in the gallbladder in the absence of sectorial bile stasis [67][68][69], regardless of alterations in bile composition. This statement has important implications for both epidemiologic and clinicopathologic purposes.…”

“…In these cases, the use of chemolitholytic drugs, even if effective in stone dissolution in some patients with cholesterol stones, is only a temporary treatment if bile duct stricture is associated. In fact, all gallstones that form cranially to a stricture are invariably going to recur, because of sectorial bile stasis, if the stricture persists [67][68][69].…”