In vitro comparison of different gall stone dissolution solvents

Article Abstract:

Gallstones are concretions formed in the bile ducts or the gallbladder. Most frequently, gallstones are composed largely of cholesterol, and are formed when the bile contains more cholesterol than will stay in solution; the precipitated cholesterol forms stones which may cause pain, colic, and flatulence when they block the bile ducts. Extracorporeal shock wave lithotripsy (ESWL), a procedure in which focussed shock waves are passed through the abdominal region, shattering the gallstones but leaving the soft tissues unscathed, is a promising nonsurgical treatment for gallstones. Follow-up treatment with expensive medication for 6 to 12 months after ESWL makes this procedure less than ideal. An alternative treatment, and one which is coming into more widespread use (in some cases as an adjunct to ESWL therapy) is the dissolution of gallstones with a cholesterol solvent; the dissolved stones can pass harmlessly through the biliary system and are excreted. To evaluate the in vitro (outside the body) capacity of different solvents to dissolve gallstones, nine sets of five human gallstones that had been surgically removed were subjected to dissolution by one of four solvents (methyl tert-butyl ether, mono-octanoin, limonene, and a 70:30 mixture of limonene and mono-octanoin). Eight of the sets of gallstones that were composed of cholesterol were completely dissolved by all solvents, leaving a sand-like debris. Methyl tert-butyl ether dissolved cholesterol gallstones 100 times faster than mono-octanoin and 10 times faster than either of the other two solvents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Usage, Composition, Solvents, Lithotripsy

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Gall stone dissolution with methyl tert-butyl ether: how to avoid complications

Article Abstract:

Gallstones are a painful condition in which cholesterol precipitates out of the bile fluid, forming solid masses within the gall bladder. This condition may be treated with surgery, by long-term administration of bile salts, or by a recently described technique of instilling a solvent (tert-butyl ether) into the gall bladder through a needle introduced under local anesthesia. The latter technique is rapid and relatively easy. Complications which may ensue include injury to the gall bladder by the needle, leakage of blood into the gall bladder following blood vessel puncture, bile leakage at the liver surface, and blockage of the gall bladder duct by the gallstone during the procedure. Analysis was done of the records of 50 patients in which this procedure was carried out with efforts to minimize the aforementioned pitfalls. In 96 percent (48) of these patients, the gall bladder was successfully cannulated and injected with tert-butyl ether (in 4 percent of the cases, extreme obesity prevented the catheterization). In the 48 patients treated, the gallstones dissolved, in an average of 9.5 hours. Twenty-four percent of the patients complained of unpleasant after-effects of the procedure, including nausea, vomiting, and burning sensations. The adoption of special precautions allowed 44 patients to be treated with no serious complications, and it was found that the mild complications such as nausea could be minimized by short treatment times and small volumes of tert-butyl ether. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy

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Pancreatic duct abnormalities in gall stone disease: an endoscopic retrograde cholangiopancreatographic study

Article Abstract:

Gall stone disease is a condition affecting the pancreas in which solid masses, frequently consisting largely of cholesterol deposits, interfere with the passage of digestive enzymes from the pancreas to the intestines via the bile ducts. If the bile ducts become blocked, the digestive enzymes may damage the pancreas, a condition known as pancreatitis. To assess the condition of the pancreatic bile ducts of patients with gall stone disease, cholangiopancreatograms (X-ray of the duct structures using a radioactive substance) from 50 patients with gall stone disease and 30 normal control subjects were analyzed. Forty-eight percent of the patients were judged to have abnormal pancreatic structure, whereas this was the case in only 6 percent of the normal subjects. Abnormalities were more likely to occur, and were of greater severity, in patients with gallstones in the biliary tree (the passageways from the pancreas to the intestines). In 16 percent of the patients, pancreatic abnormalities were severe enough to be considered chronic pancreatitis. Whether the patients with less severe pancreatic abnormalities will improve or worsen to the point of chronic pancreatitis can only be determined by long-term follow-up. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Diagnosis, Prognosis, Pancreatitis, Pancreatic duct

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