Biliary lithotripsy: a perspective

Article Abstract:

Lithotripsy is a new nonsurgical procedure used to treat gallstones. Patients are put into a tub of water while high-energy shock waves are directed through the abdominal wall toward the stones. The stones then break up into pieces small enough to be passed in the urine. Three lithotriptors, the instruments used to create shock waves, are manufactured. Spark-gap lithotriptors produce sparks between two electrodes (like a spark plug in a car) focused toward the stones by a reflector. Piezoelectric lithotriptors use ceramic tiles to tighten the focus of shock waves. Electromagnetic systems create shock waves by rapidly repelling a metal plate (like a loudspeaker) focused by a lens. All three methods create shock waves with differing patterns and intensities, and have different sized and shaped areas of focused pressure. Lithotripsy treatments should be safe, effective, relieve current symptoms, and prevent recurrences. The effectiveness of this technique must be compared with the current method of choice, cholecystectomy, or surgical removal of the gallbladder. In addition, complication rates and long-term costs of lithotripsy must be studied. The success of lithotripsy is dependent on the character and size of the gallstones; best results are achieved with single stones smaller than 20 millimeters in diameter. Only 15 percent of patients are good candidates for lithotripsy. At this time surgery remains the method of choice for treating patients with gallstones who are young and healthy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Lithotripsy

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Nonsurgical treatment of gallstones

Article Abstract:

Gallstones, deposits found in the gallbladder, are commonly treated by surgical removal of the gallbladder. The nonsurgical removal of gallstones includes the use of oral litholytic (stone- dissolving) therapies, effective for small stones. However, stones can recur after this treatment. The method investigated here uses an injection of a chemical, methyl tert-butyl ether (MTBE), directly into the gallbladder, to dissolve the stones. Only cholesterol stones can be treated using this method, whereas knowledge of stone type is unnecessary for surgical removal. Complete disappearance of the stone occurred in 96 percent of the patients selected for study. Methyl tert-butyl ether is a very dangerous and volatile substance which has to come in direct contact with the stone to be effective. This requires physician expertise. Stones recurred in 14 percent of the patients using this treatment. Other methods of treatment for gallstones use sound waves to break the stone into smaller pieces (lithotripsy). A combination of shock waves and stone dissolving therapies is a consideration. Surgical removal is still the main treatment of gallstones, with non-surgical treatments a possible alternative.

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Dissolution of cholesterol gallbladder stones by methyl tert-butyl ether administered by percutaneous transhepatic catheter

Article Abstract:

Cholesterol gallstones, affecting 16 million people in the United States, are usually treated by surgical removal. Another method is to infuse the chemical methyl tert-butyl ether (MTBE) by means of a small tube inserted into the ducts entering gallbladder from the liver, dissolving the stones within minutes to hours. Infusion of MTBE directly into the gallbladder was performed on 75 patients over a period of one to three days. Gallstones were more than 95% dissolved in 72 patients. Of 21 whose stones had dissolved completely, 4 patients had recurrences within 16 months, and 51 had residual pieces; the pieces spontaneously disappeared in 15 patients within six to 35 months. Only six patients required surgery within six to 42 months. Long-term effectiveness needs to be established, but the use of MTBE is a possible alternative to the surgical removal of cholesterol gallstones in selected patients.

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