Nonsurgical management of cholelithiasis

Article Abstract:

Cholelithiasis (gallstones) is very common, and affects about 10 percent of the American population. It is more common among women, and occurs in 25 percent of women by age 55. In most patients, these stones remain asymptomatic, but surgical removal of the gall bladder is necessary for 500,000 patients in the United States each year. However, new therapeutic options have become available in addition to surgery. Gallstones are generally either pigment gallstones, which are composed of bile pigments of modified bilirubin, or cholesterol stones. Cholesterol stones account for the majority of cases. Recent developments in therapy for gallstones have provided new alternatives to surgery, although surgery remains the treatment of choice for patients with severe symptoms or complications. Many of these new therapies involve the use of compounds to dissolve the stones. Chenodeoxycholic acid was first introduced for this purpose, but tended to cause side effects such as diarrhea and abnormal liver function. Ursodeoxycholic acid has now been presented as an alternative that does not produce significant undesirable reactions. Patients with small stones of high cholesterol content are most likely to benefit from this treatment, although a recurrence rate of 10 percent per year for the first five years has been reported with this treatment. The effectiveness of stone dissolution can be improved by the use of extracorporeal shock wave lithotripsy (ESWL), which crushes the stones into smaller bits. ESWL is normally combined with dissolution therapy and has been shown to be safe and effective. Early reports indicate that the recurrence rate may be similar to that observed with dissolution therapy alone. A more technically difficult procedure is the use of methyl-tert-butyl ether to dissolve gallstones; the substance cannot be taken orally, and must be injected directly into the gall bladder. The procedure is most useful for patients who are poor surgical risks or who refuse surgery. The best choice for treatment of gallstones will generally be determined by the patient's medical condition and preference. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Ursodiol, Lithotripsy, Common bile duct calculi

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Percutaneous gallbladder intervention

Article Abstract:

Percutaneous interventions (e.g. drainage through the skin by means of a catheter) for treatment of gallbladder problems have been used for just over the last 10 years. Initially, there was concern over the safety of these procedures, but research over the past five years has shown them to be safe and effective. Radiologists play an important role in such treatment. Two articles in the July 1990 issue of Radiology examine percutaneous gallbladder interventions. The first, by vanSonnenberg et al, examines the role of percutaneous cholecystostomy (making an opening in the gallbladder) in treating patients with inflamed and obstructed gallbladders who also have other risk factors, such as age or cardiac disease. In selected patients, this procedure can be performed easily and it provides temporary decompression until more permanent treatments can be safely performed. The second article, by Cope et al., examines using the procedure to remove gallstones. The results were highly encouraging, although the complication rate was high and the technique is complex and difficult to learn. Advantages of this technique in removing gallstones are that it requires no anesthesia nor any expensive equipment or hazardous materials. Disadvantages include the time needed to successfully remove the stones and the fact that it leaves the diseased gallbladder in place, which is associated with a high likelihood of recurrence of disease or even of the development of cancer. A new procedure being developed, laparoscopic cholecystectomy, may result in reevaluation of this procedure in treating gallbladder problems nonsurgically. This procedure can remove the gallbladder with minimal invasion or side effects. Percutaneous cholecystostomy is currently useful in treating gallbladder disease, but its future usefulness may be reduced if the new technique of laparoscopic cholecystectomy lives up to its expectations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Surgery, Gallbladder diseases, Cholecystectomy, editorial, Gallbladder

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Gallstones

Article Abstract:

Some 10% of people have gallstones, but in the majority of cases the condition is asymptomatic. An overview of the condition, risk factors and treatment is given.

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