Abstract
Intrahepatic gallstone disease (hepatolithiasis) is commonly described as oriental cholangiohepatitis, a problem seen frequently in East Asia Although relative incidence seems to be decreasing, it continues to be a serious health care problem in Japan, for its intractable nature and later development of bile duct cancer. The Study Group of Hepatolithiasis in Japan (Granted by Ministry of Health, Labour and Welfare) conducted nationwide epidemiologic survey for 5 times in the past (1977, 1984, 1988, 1992, and 1995). The similar epidemiology survey was conducted last year. It is also not well known how the disease and its treatment relate to the prognosis, recurrence of stone, and cancer development. A cohort of 473 patients in 1995 study was followed up last year. A total of 2592 hospitals in Japan were surveyed, and 331 cases were collected. Proportion of hepatolithiasis in all gallstone diseases were calculated 0.6% in this study, which compared less to previous studies (cf. 1977 4.1%, 1998 1.7%). Mean age of the patients was 63 years old, same as in the 1998 study. Male/female ratio continued to be 1: 1.2. Residual stone after initial treatment was found in 18.6% of patients, and recurrence rate remains unchanged despite for the modern imaging modalities and progress in treatment (cf. 1977 23.5%, 1998 18.4%). Concurrent cholangiocarcinoma was identified in 5.4% of patients. Parasitic disease seemed no relevance to hepatolithiasis. One hundred ninty-two cases (62.5%) had a history of previous biliary disease, cholecystlithiasis in 58 and CBD stone in 117. In addition to biliary neoplasia, it was notable that neoplasia in other organs were frequent (n=20, 7.5%). Surgical treatment was performed in 189 cases, predominantly hepatectomy of the affected lobe. Also medical treatment was performed in 145 cases and endoscopic stone removal (either PTCSL or ERCP) was the mainstay. A cohort study was analyzed as a proportional hazard model. Five year survival rate was 85.2%, and 10years rate was 78.6%. Jaundice and bile duct neoplasia significantly relate to patient's death and cholecystectomy and cholangitis related cholangiocarcinoma development. Cholangitis was found to significantly relate to stone recurrence and administration of UDCA had no relevance. Patients with hepatolithiasis are decreasing but the refractory nature of the disease is unchanged. Cancer development both in the biliary system and in other organs continues issue of concern.
