Gallstone dissolution in vitro using methyl tert-butyl ether: radiologic selection criteria.

Abstract:

:Methyl tert-butyl ether dissolves cholesterol gallbladder stones when infused through a percutaneous transhepatic catheter. All gallstones, however, contain noncholesterol components that are insoluble in lipid solvents and may be too large to be aspirated through a small catheter or flushed from the gallbladder. To identify which patients have gallstones that are most likely to completely dissolve, we evaluated the ability of methyl tert-butyl ether to dissolve gallstones in vitro based on their radiodensity and size. Radiodensity influenced completeness of dissolution (p less than 0.01), but size did not (p greater than 0.5). Twenty-six of 32 radiolucent stones (81%) dissolved completely, leaving residual debris less than 2 mm in diameter. Only 2 of 32 radiopaque stones (6%) dissolved completely. Insoluble radiolucent and radiopaque stones less than 0.5 cm in diameter were black pigment stones. Four radiolucent and 19 of 22 radiopaque stones (86%) greater than 0.5 cm in diameter underwent partial dissolution leaving residual debris 2 mm or larger. By infrared spectroscopy, calcium bilirubinate and calcium carbonate were identified as the principal components of this methyl tert-butyl ether-insoluble debris. Until methods for dissolving or fragmenting noncholesterol components of gallstones are available, only patients with radiolucent gallstones should be treated with methyl tert-butyl ether.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Nelson PE,Moyer TP,Thistle JL

doi

10.1016/s0016-5085(12)90345-5

subject

Has Abstract

pub_date

1990-05-01 00:00:00

pages

1280-3

issue

5 Pt 1

eissn

0016-5085

issn

1528-0012

pii

0016-5085(90)90345-2

journal_volume

98

pub_type

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