Endoscopic resection of intrahepatic septal stenosis: minimally invasive approach to manage hepatolithiasis after choledochal cyst excision

Intrahepatic calculi frequently form after excision of a choledochal cyst. Biliary stenosis is one of the major causative factors. When stenoses exist in the peripheral intrahepatic duct, hepatectomy is necessary. A new endoscopic management was performed in a 6-year-old girl, who had intrahepatic calculi, 4 years after cyst excision. A septal stenosis in the left lateral anterior branch of the bile duct interfered with evacuation of the intrahepatic stones. The stenosis was grasped with a 3-prong grasper, applied through a choloangioscope, and resected when current was applied to an electrocauery. The stenotic bile duct was widened, and the stones were easily removed. Intrahepatic calculi have not recurred for 2 years. The present technique is another modality for the correction of biliary stenoses.