[Results of the treatment with biliary dissolvents]

Cholesterol gallstones can be dissolved by chenodeoxycholic acid or by ursodeoxycholic acid administered orally. This treatment is subject to the following conditions: the gallbladder must be functioning; the gallstones must be radiolucent; the stones must not be too large; the main bile ducts must be patent; the cholelithiasis must be symptomatic but without severe complications. The two biliary acids are equally effective, but ursodeoxycholic acid is preferred to chenodeoxycholic acid because it is devoid of undesirable side-effects. The effectiveness of treatment varies from one published series to the other, but it primarily depends on the size of the gallstones: if they are less than 5 mm wide dissolution can be obtained in 70 to 80% of the cases. After the end of treatment the bile becomes lithogenic again, and a relapse is possible; after 5 years this relapse occurs in about 50% of the patients. The position occupied by biliary acids in the treatment of gallstones is modest, owing to the conditions of their use and to the advantages of surgery, and notably laparoscopic surgery. Biliary acids are usually given to elderly people or to subjects at high risk for anaesthesia or surgery. Attempts have been made to introduce another cholesterol dissolvant, methyl-tert-butyl-ester, directly into the gallbladder by the transcutaneous-transhepatic route. The gallstones were dissolved, but the invasiveness of this technique and the potential toxic effects of this particular drug are such that the indications for this treatment are extremely reduced.