A prospective study was undertaken to evaluate the long-term results of percutaneous trans-hepatic cholangioscopic lithotomy in 48 patients with hepatolithiasis during a 4- to 10-year follow-up period. Complete clearance of the intrahepatic stones was achieved in 40 patients (83.3%). In these 40 patients, long-term results during the follow-up period were as follows: free of symptoms and without evidence of recurrent stones, 22 patients (55%); free of symptoms with recurrent stones, 2 patients; recurrent stones with cholangitis, 14 patients (35%); symptoms of cholangitis without evidence of recurrent stones, 2 patients. Of those patients with recurrent stones, secondary biliary cirrhosis developed in 1, and in 9 of the patients in whom secondary cholangitis developed, subsequent laparotomy or percutaneous drainage was required. Three of the 40 patients (7.5%) died within the 4- to 10-year follow-up period. The procedural failure rate in terms of stone retention was 20.5% for patients with bile duct strictures. No stones were retained in patients without strictures. The postprocedural rate of stone recurrence for patients with bile duct strictures was 51.6%; no recurrence was seen in patients without strictures. (Gastrointest Endosc 1995;42:1-5.)