Radiological biliary intervention for stone disease.

Gallstones are primarily crystalline cholesterol formations that may present significant medical concerns, often leading to bile duct obstruction. Their genesis is multifaceted, influenced by genetics, diet and age. Over the decades, the biliary stone management domain has undergone a transformation, propelled by clinical demands and technological advances. This review focuses on percutaneous treatments, highlighting the shift from foundational percutaneous transhepatic cholangiography to advanced percutaneous transhepatic cholangioscopy, emphasizing patient safety, efficacy, and outcomes. The significance of patient-reported outcomes, capturing aspects that include pain and post-intervention quality of life, is accentuated. A critical analysis reveals a gap in our understanding of the long-term resilience of percutaneous interventions, particularly with respect to averting stone recurrence or treating chronic strictures. The potential of technological enhancements, including advanced endoscopes and real-time imaging, is acknowledged, though the need for rigorous clinical validation must be stressed. Decision-making challenges, due to the myriads of available interventions, are highlighted, emphasizing the need for evidence-based algorithms. Economically, the cost dynamics, both direct and ancillary, of these interventions come to the forefront. Concluding, the paper advocates for continuous innovation, ensuring that biliary stone management remains efficient, patient-centered, safe, and economically justified.