Abstract
Hepatolithiasis is a condition characterized by the presence of bile stones in the intrahepatic bile ducts. It represents a significant therapeutic challenge owing to its association with recurrent cholangitis, biliary obstruction, and potentially life-threatening complications such as hepatic abscesses and cholangiocarcinoma. Traditional treatments include hepatectomy and percutaneous transhepatic cholangioscopic lithotomy (PTCL), both of which are effective but highly invasive, whereas endoscopic approaches often leave residual stones. We report a case of recurrent hepatolithiasis with abscesses in an 80-year-old woman who had failed to respond to conventional endoscopic approaches. Endoscopic ultrasound (EUS)-guided hepaticogastrostomy was successfully performed through the transgastric approach to allow access to intrahepatic stones for clearance with complete symptomatic relief and no further evidence of recurrence during follow-up. This case demonstrates the use of hepaticogastrostomy as a less invasive alternative to surgery while serving both diagnostic and therapeutic purposes. Further studies are needed to delineate its role as well as its long-term efficacy in the management of hepatolithiasis.