LAUSR

Hepatolithiasis or intrahepatic duct calculi is one of the most complex stone diseases as it poses a great challenge in treatment and also has strong propensity for recurrence. It may be complicated by bile duct strictures, cholangiolytic abscesses, and cholangiocarcinoma [1]. The main endpoint of the treatment for hepatolithiasis would be stone clearance, stricture correction, and restoration of biliary drainage [2]. A 27-year-old woman was referred to our department for right upper quadrant pain of the abdomen and fever for 3 days. Patient was hemodynamically stable. Her blood investigations were unremarkable except for elevated liver enzymes (AST 69 IU/L, ALT 71 IU/L, and ALP 354 IU/L). Magnetic resonance cholangiopancreatography showed one calculus measuring 6mm in the right anterior sectoral duct with upstream biliary dilatation and another small calculus in the distal bile duct (▶Fig. 1). Endoscopic retrograde cholangiopancreatography (ERCP) revealed a filling defect in the lower end of the bile duct and in the right hepatic duct. The sludge material came out after biliary sphincterotomy. A cholangioscope (SpyGlass DS; E-Videos