Cholesterol gall stone dissolution using MTBE: study of efficacy, safety and prevention of recurrence

ABSTRACT

Twenty-three patients, 4 males and 19 females [mean age 38.6 years], with symptomatic noncomplicated cholesterol gall stone[s] were treated by percutaneous transhepatic direct contact MTBE dissolution. All patients were evaluated clinically and ultrasonographically before and after dissolution. Also, CT scan evaluation was done before dissolution to detect any calcification and to assure good gall bladder bed. Patients were classified into two groups Group 1 [12 patients including 2 patients with residual stones], received ursodeoxycholic acid for three months after dissolution and group 2 [11 patients] did not receive ursodeoxycholic acid therapy. In 21 patients, first time gallbladder puncture was successful [91%], and in 2 obese patients second punctures [5 and 2 months later], were successful using stiffer catheter. Average dissolution time was 8.47 hours. Gall stone dissolution rate ranged from 0.98 to 3.4 cm/hour. The rate of dissolution was increased with the increase in stone number and stone burden. Complete stone dissolution was achieved in 21 patients [91.3%], residual gall bladder sediment not casting posterior shadow on ultrasound examination was detected in 3 patients [13.04%]. Residual stone fragments escaped dissolution in 2 patients [8.69%]. Side effects of the procedure were minimal and no major complications occurred. Results of 3 years follow up showed only one genuine recurrence [10%] out of 10 patients who received prophylactic post dissolution therapy in group 1, while 5 out of the 11 patients in group 2 showed recurrence [45.45%]. Direct contact MTBE cholesterol gall stone dissolution is safe and effective alternative for surgery. Post dissolution ursodeoxycholic acid therapy for 3 months is highly effective in preventing recurrence of stones