Direct contact dissolution therapy

Direct contact dissolution using MTBE is a safe, effective treatment for many patients with cholesterol gallstones when performed by clinicians experienced with this technique. This may be the treatment of choice for many patients at high risk for general anaesthesia or surgery. Cholecystostomy using local anaesthesia with subsequent stone extraction is an alternative requiring prolonged catheter drainage, and is associated with some risk and discomfort (Hawkyard et al, 1990). Most experts concur that laparoscopic cholecystectomy cannot be performed safely and comfortably without general anaesthesia under most circumstances. A second small population of patients are inordinately apprehensive about general anaesthesia or surgical removal of their gallbladder and refuse standard therapy in spite of recurrent biliary symptoms. Although direct contact dissolution is generally well tolerated, it may require several days of paramedical attention with medical supervision. This procedure will be most efficiently, effectively and comfortably performed by an experienced team and is, therefore, probably best provided by referral centres with physicians sufficiently interested in the treatment of biliary tract stone disease to develop expertise with this method.