In contrast, HL in Western cohorts is generally non-infectious and may be secondary to gallstone migration, post-surgical biliary strictures, congenital anomalies (e.g., Caroli disease), or metabolic predispositions such as ABCB4 (MDR3) mutations that impair phospholipid secretion [12,13,14]. This evidence concerns the gene ABCB4 and gallstones.