[Non-surgical therapy of gall stones]

Currently, a remarkable selection of alternatives to cholecystectomy is available. These new techniques undoubtedly will expand management without laparotomy of both common bile duct and gallbladder disease. Endoscopic sphincterotomy with stone removal has gained wide acceptance for retained or recurrent common bile duct stones. Chenodiol and Ursodiol are save and effective agents, either alone or in combination for the medical dissolution of gallbladder stones in selected patients. Infusion of methyl tert-butyl ether, which is liquid at body temperature, via a catheter into the gallbladder allows rapid dissolution of cholesterol gallstones. Extracorporal shock-wave lithotripsy (ESWL), which has already revolutionized therapy of urolithiasis, has been introduced as another promising nonoperative treatment for selected patients with gallbladder stones. Again ESWL has been reported useful in patients with bile duct stones not amenable to manipulative, endoscopic measures. The choice of appropriate therapy for individual patients depends on different factors, i.e. medical condition of the patient, chemical composition of the stones and availability of lithotriptors, respectively. The appropriate therapy will depend on these factors and the patients preference.